{ "hospital_name": "Jacobson Memorial Hospital Care Center", "last_updated_on": "2026-03-01", "version": "3.0.0", "location_name": [ "Jacobson Memorial Hospital Care Center" ], "hospital_location": [ "Jacobson Memorial Hospital Care Center" ], "hospital_address": [ "601 East Street North, Elgin, ND 58533" ], "license_information": { "state": "ND", "license_number": "5014" }, "type_2_npi": [ "1336196039" ], "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.", "attester_name": "Kristin Heid", "confirm_attestation": true }, "affirmation": { "affirmation": "To the best of its knowledge and belief, the 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 indicated in the file.", "confirm_affirmation": true }, "standard_charge_information": [ { "description": "SKILLED SWING PRIVATE", "code_information": [ { "code": "110", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 239.4, "maximum": 558.6, "gross_charge": 399.0, "discounted_cash": 299.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 239.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 399.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 399.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 558.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 359.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 359.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 359.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 399.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 319.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 399.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 359.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 399.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.68, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 399.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 478.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 399.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 319.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 299.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 304.04, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 399.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SKILLED SWING ROOM & BRD SEMI", "code_information": [ { "code": "120", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 233.4, "maximum": 544.6, "gross_charge": 389.0, "discounted_cash": 291.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 389.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 389.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 544.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 389.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 311.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 389.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 389.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.52, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 389.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 466.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 389.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 311.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 291.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 296.42, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 389.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SEMI PRIVATE ROOM", "code_information": [ { "code": "120", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7204.8, "maximum": 16811.2, "gross_charge": 12008.0, "discounted_cash": 9006.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 7204.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 12008.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 12008.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 16811.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 10807.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 10807.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 10807.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 12008.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 9606.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 12008.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 10807.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 12008.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 8597.73, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 12008.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 14409.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 12008.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 9606.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 9006.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 9150.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 12008.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SKILLED SWING R&B SEMI LVL II", "code_information": [ { "code": "120", "type": "RC" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17544.6, "maximum": 40937.4, "gross_charge": 29241.0, "discounted_cash": 21930.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17544.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 29241.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 29241.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 40937.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26316.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26316.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 26316.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29241.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23392.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29241.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26316.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 29241.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 20936.56, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29241.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 35089.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 29241.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23392.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 21930.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22281.64, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29241.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "INTENSIVE CARE GENERAL", "code_information": [ { "code": "200", "type": "RC" } ], "standard_charges": [ { "setting": "both", "minimum": 1250.4, "maximum": 2917.6, "gross_charge": 2084.0, "discounted_cash": 1563.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1250.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2084.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2084.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2917.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1875.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1875.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1875.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2084.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1667.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2084.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1875.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2084.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1492.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2084.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2500.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2084.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1667.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1563.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1588.01, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2084.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IV HYDRAT INITIAL 31-60MINS", "code_information": [ { "code": "96360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 214.02, "maximum": 499.38, "gross_charge": 356.7000000000003, "discounted_cash": 267.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.02, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 356.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 356.7000000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 499.38, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.03, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.03, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.03, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 356.7000000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.36, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 356.7000000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.03, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 356.7000000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.4, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 356.7000000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.04, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 356.7000000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.36, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 267.53, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.81, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 356.7000000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IV HYDRATION EACH ADDL HR", "code_information": [ { "code": "96361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1871.7, "maximum": 4367.3, "gross_charge": 3119.499999999999, "discounted_cash": 2339.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1871.7, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3119.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3119.499999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4367.3, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2807.55, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2807.55, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2807.55, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3119.499999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2495.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3119.499999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2807.55, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3119.499999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2233.56, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3119.499999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3743.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3119.499999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2495.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2339.62, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2377.06, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3119.499999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IV INFUSION TX PROPH DX INIT TO 1HR", "code_information": [ { "code": "96365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1391.13, "maximum": 3245.97, "gross_charge": 2318.550000000002, "discounted_cash": 1738.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1391.13, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2318.55, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2318.550000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3245.97, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2086.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2086.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2086.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2318.550000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1854.84, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2318.550000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2086.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2318.550000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1660.08, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2318.550000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2782.26, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2318.550000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1854.84, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1738.91, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1766.74, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2318.550000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IV INFUSION EA ADD HR", "code_information": [ { "code": "96366", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3820.47, "maximum": 8914.43, "gross_charge": 6367.449999999998, "discounted_cash": 4775.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3820.47, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 6367.45, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 6367.449999999998, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 8914.43, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5730.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5730.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 5730.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 6367.449999999998, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5093.96, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 6367.449999999998, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5730.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 6367.449999999998, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 4559.09, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 6367.449999999998, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 7640.94, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 6367.449999999998, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5093.96, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 4775.59, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4852.0, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 6367.449999999998, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IV INFUS ADD SEQUEN NEW DRG1HR", "code_information": [ { "code": "96367", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 248.88, "maximum": 580.72, "gross_charge": 414.8000000000002, "discounted_cash": 311.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 248.88, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 414.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 414.8000000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 580.72, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 373.32, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 373.32, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 373.32, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 414.8000000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.84, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 414.8000000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 373.32, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 414.8000000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 297.0, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 414.8000000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 497.76, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 414.8000000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.84, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 311.1, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 414.8000000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SC IM INJECTION", "code_information": [ { "code": "96372", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3562.1, "maximum": 8311.56, "gross_charge": 5936.825000000003, "discounted_cash": 4452.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3562.1, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 5936.83, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 5936.825000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 8311.56, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5343.14, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5343.14, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 5343.14, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 5936.825000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4749.46, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 5936.825000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5343.14, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 5936.825000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 4250.77, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 5936.825000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 7124.19, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 5936.825000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4749.46, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 4452.62, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4523.86, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 5936.825000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IV PUSH INITIAL", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 713.4, "maximum": 1664.6, "gross_charge": 1189.000000000001, "discounted_cash": 891.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 713.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1189.000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1664.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1070.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1070.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1070.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1189.000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 951.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1189.000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1070.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1189.000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 851.32, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1189.000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1426.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1189.000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 951.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 891.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 906.02, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1189.000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IV PUSH SEQUENTIAL NEW DRUG", "code_information": [ { "code": "96375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 539.49, "maximum": 1258.81, "gross_charge": 899.1499999999997, "discounted_cash": 674.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.49, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 899.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 899.1499999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1258.81, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 809.23, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 809.23, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 809.23, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 899.1499999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 719.32, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 899.1499999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 809.23, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 899.1499999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 643.79, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 899.1499999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1078.98, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 899.1499999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 719.32, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 674.36, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 685.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 899.1499999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IV PUSH ADDL SAME DRUG >30MINS", "code_information": [ { "code": "96376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 453.6, "maximum": 1058.4, "gross_charge": 756.0, "discounted_cash": 567.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 453.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1058.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 680.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 680.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 680.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 604.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 680.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 541.3, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 907.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 604.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 567.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 576.07, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TRANSFUSION BLOOD", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2661.33, "maximum": 6209.77, "gross_charge": 4435.550000000001, "discounted_cash": 3326.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2661.33, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 4435.55, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 4435.550000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 6209.77, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3992.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3992.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 3992.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 4435.550000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3548.44, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 4435.550000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3992.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 4435.550000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 3175.85, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 4435.550000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 5322.66, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 4435.550000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3548.44, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 3326.66, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3379.89, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 4435.550000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IMMUN ADMIN 1 VACCINE", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 42.6, "maximum": 99.4, "gross_charge": 71.0, "discounted_cash": 53.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 71.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 71.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 99.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 71.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 71.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 71.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.84, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 71.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 71.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 53.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 71.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ADMIN INFLUENZA VIR VAC", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 40.8, "maximum": 95.2, "gross_charge": 68.0, "discounted_cash": 51.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 95.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.69, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 90471 IMMUNE ADMIN 1 VACCINE", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 42.0, "maximum": 98.0, "gross_charge": 70.0, "discounted_cash": 52.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 98.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 52.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 90472 IMMUN ADMIN EA ADDL VACCINE", "code_information": [ { "code": "90472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 30.0, "maximum": 70.0, "gross_charge": 50.0, "discounted_cash": 37.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.8, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 37.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IMMUN ADMIN EA ADDL VACCINE", "code_information": [ { "code": "90472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 30.0, "maximum": 70.0, "gross_charge": 50.0, "discounted_cash": 37.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.8, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 37.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CONTIN GLUCOSE MONITORING ANALYSIS I&R 72HR", "code_information": [ { "code": "95251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 31.8, "maximum": 74.2, "gross_charge": 53.0, "discounted_cash": 39.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 53.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 53.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 74.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 53.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 53.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 53.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.95, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 53.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 53.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 39.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.39, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 53.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IRRIG IMPL VENOUS ACCESS DEVIC", "code_information": [ { "code": "96523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 84.0, "maximum": 196.0, "gross_charge": 140.0, "discounted_cash": 105.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 196.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.24, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.68, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "THERAPEUTIC PHLEBOTOMY", "code_information": [ { "code": "99195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 279.0, "maximum": 651.0, "gross_charge": 465.0, "discounted_cash": 348.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 465.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 465.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 465.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 372.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 465.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 465.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 332.94, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 465.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 558.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 465.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 372.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 348.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.33, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 465.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "THERAPEUTIC PHLEBOTOMY NURSING", "code_information": [ { "code": "99195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 279.0, "maximum": 651.0, "gross_charge": 465.0, "discounted_cash": 348.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 465.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 465.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 465.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 372.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 465.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 465.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 332.94, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 465.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 558.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 465.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 372.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 348.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.33, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 465.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PHASE 1 INPT CARDIAC REHAB", "code_information": [ { "code": "93798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 67.8, "maximum": 158.2, "gross_charge": 113.0, "discounted_cash": 84.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 113.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 113.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 158.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 113.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 113.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 113.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.91, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 113.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 113.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 84.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 113.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 10040 ACNE SURGERY", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 10060 I&D ABSCESS SIMPLE", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 10061 INC&DRNG ABSCESS MULT COMPLIC", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 468.0, "maximum": 1092.0, "gross_charge": 780.0, "discounted_cash": 585.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 468.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 780.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 780.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1092.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 702.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 702.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 702.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 780.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 624.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 780.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 702.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 780.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 558.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 780.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 936.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 780.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 624.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 594.36, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 780.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 10081 I & D PILONIDAL CYST COMPL", "code_information": [ { "code": "10081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 10140 DRAIN HEMATOMA SEROMA", "code_information": [ { "code": "10140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1692.0, "maximum": 3948.0, "gross_charge": 2820.0, "discounted_cash": 2115.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1692.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3948.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2019.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3384.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2148.84, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11042 DEBR SKIN SUBQ TISSUE", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11055 PARING OR CUTTING BENIGN SINGLE LESION", "code_information": [ { "code": "11055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11102 TANGENTIAL BX SKIN SINGLE LESION", "code_information": [ { "code": "11102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11104 PUNCH BX SKIN SINGLE LESION", "code_information": [ { "code": "11104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11105 PUNCH SKIN BX EA SEP/ADDL", "code_information": [ { "code": "11105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 213.6, "maximum": 498.4, "gross_charge": 356.0, "discounted_cash": 267.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 356.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 356.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 498.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 356.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 356.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 356.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.9, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 356.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 427.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 356.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 267.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.27, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 356.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11106 INCISIONAL BX SKIN SINGLE LESION", "code_information": [ { "code": "11106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 628.2, "maximum": 1465.8, "gross_charge": 1047.0, "discounted_cash": 785.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 628.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1465.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 837.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 749.65, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1256.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 837.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 785.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 797.81, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11107 INCISIONAL BX SKIN EA SEP OR ADDL LESION", "code_information": [ { "code": "11107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 382.2, "maximum": 891.8, "gross_charge": 637.0, "discounted_cash": 477.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 382.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 637.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 637.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 891.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 637.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 509.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 637.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 637.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 456.09, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 637.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 764.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 637.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 509.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 477.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 485.39, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 637.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11200 REMOVE SKIN TAG UP TO 15", "code_information": [ { "code": "11200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11301 SHAVE SKIN LESN TRUNK ARMS LEGS 0.6-1.0 CM", "code_information": [ { "code": "11301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11302 SHAVE SKIN LESN TRUNK ARMS LEGS 1.1-2.0 CM", "code_information": [ { "code": "11302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11303 SHAVING SKIN LSN TRUNK/ARMS/LEGS DIAM > 2.0 CM", "code_information": [ { "code": "11303", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11305 SHAVE SNGL NK HND FT GEN .5 CM", "code_information": [ { "code": "11305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11307 SHAVE SGL NK HND FT GEN .1-2CM", "code_information": [ { "code": "11307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11311 SHAVE SKIN LESN FACEUS MEMBRANE 0.6-1.0 CM", "code_information": [ { "code": "11311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11400 EXC BENIGN LESN BGN TRUNK ARM LEG 0.5CM<", "code_information": [ { "code": "11400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 745.2, "maximum": 1738.8, "gross_charge": 1242.0, "discounted_cash": 931.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1738.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 889.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 931.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 946.4, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11401 EXC BNGN LSN TRUNK EXTREM 0.6-1.0CM", "code_information": [ { "code": "11401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11402 EXCISION LESION BENIGN TRUNK ARM LEG 1.1 TO 2.0CM", "code_information": [ { "code": "11402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 745.2, "maximum": 1738.8, "gross_charge": 1242.0, "discounted_cash": 931.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1738.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 889.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 931.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 946.4, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11403 EXC BNGN LSN TRUNK EXTREM 2.1-3.0CM", "code_information": [ { "code": "11403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 745.2, "maximum": 1738.8, "gross_charge": 1242.0, "discounted_cash": 931.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1738.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 889.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 931.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 946.4, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11404 EXC BNGN LSN TRUNK EXTREM 3.1-4.0CM", "code_information": [ { "code": "11404", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1692.0, "maximum": 3948.0, "gross_charge": 2820.0, "discounted_cash": 2115.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1692.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3948.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2019.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3384.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2148.84, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11420 EXC BNGN LSN SCALP NECK HANDS FEET GENITAL <0.5CM", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1692.0, "maximum": 3948.0, "gross_charge": 2820.0, "discounted_cash": 2115.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1692.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3948.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2019.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3384.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2148.84, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11422 EXC BNGN LSN SCALP NECK HANDS FEET GENITAL 1.1-2.0CM", "code_information": [ { "code": "11422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1692.0, "maximum": 3948.0, "gross_charge": 2820.0, "discounted_cash": 2115.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1692.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3948.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2019.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3384.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2148.84, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11423 EXC BNGN LSN SCALP NECK HANDS FEET GENITAL 2.1-3.0CM", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1692.0, "maximum": 3948.0, "gross_charge": 2820.0, "discounted_cash": 2115.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1692.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3948.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2019.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3384.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2148.84, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11441 EXC BNGN LSN FACE EAR NOSE LIP MUC MEM 0.6-1.0CM", "code_information": [ { "code": "11441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 745.2, "maximum": 1738.8, "gross_charge": 1242.0, "discounted_cash": 931.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1738.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 889.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 931.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 946.4, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11442 EXC BNGN LSN FACE EAR NOSE LIP MUC MEM 1.1-2.0CM", "code_information": [ { "code": "11442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 745.2, "maximum": 1738.8, "gross_charge": 1242.0, "discounted_cash": 931.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1738.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 889.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 931.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 946.4, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11601 EXC MAL LSN TRUNK EXTREM 0.6-1.0CM", "code_information": [ { "code": "11601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 745.2, "maximum": 1738.8, "gross_charge": 1242.0, "discounted_cash": 931.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1738.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 889.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 931.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 946.4, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11602 EXC MAL LSN TRUNK EXTREM 1.1-2.0CM", "code_information": [ { "code": "11602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 677.4, "maximum": 1580.6, "gross_charge": 1129.0, "discounted_cash": 846.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 677.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1580.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1016.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1016.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1016.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 903.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1016.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 808.36, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1354.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 903.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 846.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 860.3, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11603 EXC MAL LSN TRUNK EXTREM 2.1-3.0 CM", "code_information": [ { "code": "11603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 745.2, "maximum": 1738.8, "gross_charge": 1242.0, "discounted_cash": 931.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1738.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 889.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 931.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 946.4, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11604 EXC MAL LSN TRUNK EXTREM 3.1-4.0 CM", "code_information": [ { "code": "11604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 745.2, "maximum": 1738.8, "gross_charge": 1242.0, "discounted_cash": 931.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1738.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 889.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 931.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 946.4, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11606 EXC MAL LSN TRUNK EXTREM > 4.0 CM", "code_information": [ { "code": "11606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1692.0, "maximum": 3948.0, "gross_charge": 2820.0, "discounted_cash": 2115.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1692.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3948.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2019.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3384.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2148.84, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11622 EXC MALIG LSN S H F G 1-2.0CM", "code_information": [ { "code": "11622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 745.2, "maximum": 1738.8, "gross_charge": 1242.0, "discounted_cash": 931.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1738.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 889.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 931.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 946.4, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11623 EXC MAL LSN SCALP NECK HANDS FEET GENITAL 2.1-3.0CM", "code_information": [ { "code": "11623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1692.0, "maximum": 3948.0, "gross_charge": 2820.0, "discounted_cash": 2115.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1692.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3948.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2019.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3384.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2148.84, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11642 EXC MAL LSN FACE EAR NOSE LIP MUC MEM 1.1-2.0CM", "code_information": [ { "code": "11642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 745.2, "maximum": 1738.8, "gross_charge": 1242.0, "discounted_cash": 931.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1738.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 889.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 931.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 946.4, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11643 EXC MAL LSN FACE EAR NOSE LIP MUC MEM 2.1-3.0CM", "code_information": [ { "code": "11643", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1692.0, "maximum": 3948.0, "gross_charge": 2820.0, "discounted_cash": 2115.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1692.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3948.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2019.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3384.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2148.84, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2820.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11646 EXC MAL LSN FACE EAR NOSE LIP MUC MEM >4.0CM", "code_information": [ { "code": "11646", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2925.0, "maximum": 6825.0, "gross_charge": 4875.0, "discounted_cash": 3656.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2925.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 4875.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 4875.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 6825.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4387.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4387.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 4387.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 4875.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3900.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 4875.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4387.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 4875.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490.5, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 4875.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 5850.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 4875.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3900.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 3656.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3714.75, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 4875.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11719 TRIM NAIL(S)", "code_information": [ { "code": "11719", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 69.0, "maximum": 161.0, "gross_charge": 115.0, "discounted_cash": 86.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 161.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.34, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 86.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11730 REMOV NAIL PLATE PART COMP SGL", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11750 REMOVE NAIL BED PERMANENT", "code_information": [ { "code": "11750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 11981 INSERTION DRUG DELIV IMPLANT", "code_information": [ { "code": "11981", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 134.4, "maximum": 313.6, "gross_charge": 224.0, "discounted_cash": 168.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 313.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.38, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 168.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.69, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 12001 RPR SUPRFICIAL WND <= 2.5CM", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 12002 REPAIR LAC SIMPLE SCALP HAND FOOT GENITAL 2.6 TO 7.5CM", "code_information": [ { "code": "12002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 12011 REPAIR LAC SIMPLE FACE/EAR/LIPS <2.5CM", "code_information": [ { "code": "12011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 12013 SMPL RPR SUPERFL WNDS FACEUS MEMBRN 2.6-5.0 CM", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 16020 DRESS DEB BURN <5% TOTAL SM", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 17000 DESTRUCT PREMALG LESN 1ST", "code_information": [ { "code": "17000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 215.4, "maximum": 502.6, "gross_charge": 359.0, "discounted_cash": 269.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 502.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 269.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 17003 DESTRUCT PREMALG LESN 2-14 EA", "code_information": [ { "code": "17003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.2, "maximum": 9.8, "gross_charge": 7.0, "discounted_cash": 5.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 7.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 7.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 7.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 7.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.01, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 7.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 7.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 5.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 7.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 17110 DESTRUCT BENIGN LESN 1-14", "code_information": [ { "code": "17110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 17111 DESTRUCT BENIGN LESN 15+", "code_information": [ { "code": "17111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 222.6, "maximum": 519.4, "gross_charge": 371.0, "discounted_cash": 278.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 222.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 371.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 371.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 519.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 333.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 333.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 333.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 371.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 296.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 371.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 333.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 371.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 265.64, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 371.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 445.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 371.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 296.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 278.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.7, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 371.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 17283 DESTRUCT MALIGNANT LESN 2.1-3 CM", "code_information": [ { "code": "17283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 17286 DESTRUCT MALIGNANT LESN >4.0CM", "code_information": [ { "code": "17286", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 628.2, "maximum": 1465.8, "gross_charge": 1047.0, "discounted_cash": 785.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 628.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1465.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 837.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 749.65, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1256.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 837.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 785.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 797.81, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 20550 INJ SINGLE TENDON LIGAMENT", "code_information": [ { "code": "20550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 325.8, "maximum": 760.2, "gross_charge": 543.0, "discounted_cash": 407.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 760.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.79, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 651.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 407.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 20552 INJ TRIGGER PT 1-2 MUSCLE(S)", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 325.8, "maximum": 760.2, "gross_charge": 543.0, "discounted_cash": 407.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 760.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.79, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 651.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 407.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 20600 DRAIN INJ JOINT BURSA WO US", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 325.8, "maximum": 760.2, "gross_charge": 543.0, "discounted_cash": 407.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 760.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.79, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 651.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 407.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 20605 ARTHRO ASP INJ JOINT BURSA INTERMED WO US GUID", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 325.8, "maximum": 760.2, "gross_charge": 543.0, "discounted_cash": 407.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 760.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.79, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 651.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 407.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 20610 ARTHROCENT ASP INJ JOINT BURSA MAJOR WO US GUID", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 325.8, "maximum": 760.2, "gross_charge": 543.0, "discounted_cash": 407.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 760.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.79, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 651.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 407.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 20612 ASP INJ OF GANGLION CYST(S)", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 325.8, "maximum": 760.2, "gross_charge": 543.0, "discounted_cash": 407.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 760.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.79, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 651.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 407.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 25075 EXC FOREARM TUMOR SUBQ <3CM", "code_information": [ { "code": "25075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1809.0, "maximum": 4221.0, "gross_charge": 3015.0, "discounted_cash": 2261.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1809.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3015.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3015.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4221.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2713.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2713.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2713.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3015.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2412.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3015.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2713.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3015.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2158.74, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3015.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3618.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3015.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2412.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2261.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2297.43, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3015.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 28190 REMOVE FB FOOT SUBCU", "code_information": [ { "code": "28190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 762.6, "maximum": 1779.4, "gross_charge": 1271.0, "discounted_cash": 953.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 762.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1779.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1143.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1143.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1143.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1016.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1143.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 910.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1525.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1016.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 953.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 968.5, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 29125 APPLY FOREARM SPLIT STATIC", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 140.4, "maximum": 327.6, "gross_charge": 234.0, "discounted_cash": 175.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 327.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.54, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 280.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 175.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.31, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 29130 APPLY FINGER SPLINT STATIC", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 137.4, "maximum": 320.6, "gross_charge": 229.0, "discounted_cash": 171.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 320.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.96, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 171.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.5, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 29515 APPLY SHORT LEG SPLINT", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 177.6, "maximum": 414.4, "gross_charge": 296.0, "discounted_cash": 222.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 414.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.94, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 222.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.55, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 29580 STRAPPING UNNA BOOT", "code_information": [ { "code": "29580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 177.6, "maximum": 414.4, "gross_charge": 296.0, "discounted_cash": 222.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 414.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.94, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 222.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.55, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 30901 CNTRL NASAL HEMORR SMP ANT", "code_information": [ { "code": "30901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 131.4, "maximum": 306.6, "gross_charge": 219.0, "discounted_cash": 164.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 306.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.8, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 262.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 164.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.88, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 51700 BLADDER IRRIGATION SIMPLE", "code_information": [ { "code": "51700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 322.2, "maximum": 751.8, "gross_charge": 537.0, "discounted_cash": 402.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 322.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 537.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 537.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 751.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 483.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 483.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 483.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 537.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 429.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 537.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 483.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 537.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 384.49, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 537.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 644.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 537.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 429.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 402.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.19, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 537.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 51701 CATH BLADDER NON-INDWELLING", "code_information": [ { "code": "51701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 136.8, "maximum": 319.2, "gross_charge": 228.0, "discounted_cash": 171.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 319.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.25, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 171.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.74, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 51702 INSERT TEMP INDEWELLING CATH/SIMPLE", "code_information": [ { "code": "51702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 136.8, "maximum": 319.2, "gross_charge": 228.0, "discounted_cash": 171.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 319.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.25, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 171.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.74, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 64455 INJ ANESTH AGNT STEROID PLANTAR DIGIT", "code_information": [ { "code": "64455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 376.2, "maximum": 877.8, "gross_charge": 627.0, "discounted_cash": 470.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 376.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 627.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 627.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 877.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 564.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 564.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 564.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 627.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 627.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 564.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 627.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 448.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 627.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 752.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 627.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 470.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 477.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 627.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 64612 CHEMODENERVATION MUSCLE", "code_information": [ { "code": "64612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 376.2, "maximum": 877.8, "gross_charge": 627.0, "discounted_cash": 470.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 376.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 627.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 627.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 877.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 564.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 564.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 564.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 627.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 627.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 564.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 627.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 448.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 627.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 752.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 627.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 470.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 477.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 627.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT", "code_information": [ { "code": "69209", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 90.6, "maximum": 211.4, "gross_charge": 151.0, "discounted_cash": 113.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 211.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 113.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.06, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 69210 REMOVAL IMPACTED CERUMEN EAR WAX", "code_information": [ { "code": "69210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 91.2, "maximum": 212.8, "gross_charge": 152.0, "discounted_cash": 114.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 212.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.83, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 95115 INJ ALLERGEN IMMUNO-SGL", "code_information": [ { "code": "95115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 24.6, "maximum": 57.4, "gross_charge": 41.0, "discounted_cash": 30.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 57.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.36, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 30.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.24, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 95117 INJ ALLERGEN IMMUNO-2 OR MORE", "code_information": [ { "code": "95117", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 30.0, "maximum": 70.0, "gross_charge": 50.0, "discounted_cash": 37.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.8, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 37.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 97602 NONSELCT DEBRIDEMENT 97602", "code_information": [ { "code": "97602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 246.0, "maximum": 574.0, "gross_charge": 410.0, "discounted_cash": 307.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 410.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 410.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 574.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 410.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 328.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 410.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 410.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 293.56, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 410.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 410.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 328.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 307.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.42, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 410.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 97605 WND NEG PRESS UTILIZ DME <= 50SQCM 97605", "code_information": [ { "code": "97605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 116.4, "maximum": 271.6, "gross_charge": 194.0, "discounted_cash": 145.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 194.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 194.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 271.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 194.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 194.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 194.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.9, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 194.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 194.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 145.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.83, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 194.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 97606 WND NEG PRESS UTILIZ DME >50 SQ CM 97606", "code_information": [ { "code": "97606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 129.0, "maximum": 301.0, "gross_charge": 215.0, "discounted_cash": 161.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 215.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 215.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 301.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 215.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 215.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 215.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.94, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 215.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 215.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 161.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.83, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 215.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 97607 NEG PRESSURE WOUND TX DISP NON-DME< =50 SQ CM 97607", "code_information": [ { "code": "97607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 880.8, "maximum": 2055.2, "gross_charge": 1468.0, "discounted_cash": 1101.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 880.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1468.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1468.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2055.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1321.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1321.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1321.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1468.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1174.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1468.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1321.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1468.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1051.09, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1468.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1761.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1468.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1174.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1118.62, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1468.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 97608 NEG PRESSURE WOUND TX DISP NON-DME >50 SQ CM 97608", "code_information": [ { "code": "97608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 856.8, "maximum": 1999.2, "gross_charge": 1428.0, "discounted_cash": 1071.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 856.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1428.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1428.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1999.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1285.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1285.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1285.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1428.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1142.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1428.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1285.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1428.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1022.45, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1428.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1713.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1428.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1142.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1071.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1088.14, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1428.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TX RM 99211 TREATMENT RM LEVEL I", "code_information": [ { "code": "99211", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 29.4, "maximum": 68.6, "gross_charge": 49.0, "discounted_cash": 36.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 68.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.08, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 36.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OXYGEN/HOUR", "code_information": [ { "code": "271", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 18.0, "maximum": 42.0, "gross_charge": 30.0, "discounted_cash": 22.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 22.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.86, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OXYGEN DAILY", "code_information": [ { "code": "271", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 210.0, "maximum": 490.0, "gross_charge": 350.0, "discounted_cash": 262.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 350.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 350.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 490.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 315.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 315.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 315.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 350.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 280.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 350.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 315.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 350.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 350.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 420.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 350.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 280.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 262.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.7, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 350.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "COMPREHENSIVE METABOLIC PANEL 80053", "code_information": [ { "code": "80053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 63.36, "maximum": 147.84, "gross_charge": 105.60000000000001, "discounted_cash": 79.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.36, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 105.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 105.60000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 147.84, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.04, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.04, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.04, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 105.60000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.48, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 105.60000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.04, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 105.60000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.61, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 105.60000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.72, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 105.60000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.48, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 79.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.47, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 105.60000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "COMPLETE CBC W/AUTO DIFF WBC 85025", "code_information": [ { "code": "85025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 46.62, "maximum": 108.78, "gross_charge": 77.69999999999999, "discounted_cash": 58.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.62, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 77.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 77.69999999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 108.78, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.93, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.93, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.93, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 77.69999999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.16, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 77.69999999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.93, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 77.69999999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.63, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 77.69999999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.24, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 77.69999999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.16, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 58.27, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.21, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 77.69999999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "NATRIURETIC PEPTIDE 83880", "code_information": [ { "code": "83880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 235.56, "maximum": 549.64, "gross_charge": 392.59999999999997, "discounted_cash": 294.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.56, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 392.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 392.59999999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 549.64, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 353.34, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 353.34, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 353.34, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 392.59999999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 314.08, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 392.59999999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 353.34, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 392.59999999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.1, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 392.59999999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 471.12, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 392.59999999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 314.08, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 294.45, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 299.16, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 392.59999999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "VENIPUNCTURE 36415", "code_information": [ { "code": "36415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 18.0, "maximum": 42.0, "gross_charge": 30.0, "discounted_cash": 22.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 22.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.86, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LIPID PANEL 80061", "code_information": [ { "code": "80061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 80.34, "maximum": 187.46, "gross_charge": 133.9, "discounted_cash": 100.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.34, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 133.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 133.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 187.46, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.51, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.51, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.51, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 133.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.12, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 133.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.51, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 133.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.87, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 133.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.68, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 133.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.12, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 100.43, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.03, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 133.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "THYROID STIMULATING HORMONE (TSH) 84443", "code_information": [ { "code": "84443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 100.8, "maximum": 235.2, "gross_charge": 168.0, "discounted_cash": 126.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 168.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 168.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 235.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 168.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 168.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 168.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.29, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 168.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 168.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.02, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 168.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ASSAY OF TROPONIN QUANTITATIVE 84484", "code_information": [ { "code": "84484", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 74.82, "maximum": 174.58, "gross_charge": 124.7, "discounted_cash": 93.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.82, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 124.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 124.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 174.58, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.23, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.23, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.23, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 124.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.76, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 124.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.23, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 124.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.29, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 124.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.64, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 124.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.76, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 93.53, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.02, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 124.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CDMR GROUP A STREP PCR 87651.002", "code_information": [ { "code": "87651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 210.54, "maximum": 491.26, "gross_charge": 350.90000000000003, "discounted_cash": 263.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.54, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 350.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 350.90000000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 491.26, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 315.81, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 315.81, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 315.81, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 350.90000000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 280.72, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 350.90000000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 315.81, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 350.90000000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.24, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 350.90000000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.08, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 350.90000000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 280.72, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 263.18, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.39, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 350.90000000000003, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BASIC METABOLIC PANEL 80048", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 50.76, "maximum": 118.44, "gross_charge": 84.60000000000001, "discounted_cash": 63.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.76, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 84.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 84.60000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 118.44, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.14, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.14, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.14, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.60000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.68, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.60000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.14, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 84.60000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.57, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.60000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.52, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 84.60000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.68, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.45, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.47, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.60000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HEMOGLOBIN GLYCOSYLATED A1C 83036", "code_information": [ { "code": "83036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 58.26, "maximum": 135.94, "gross_charge": 97.10000000000001, "discounted_cash": 72.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.26, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 97.1, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 97.10000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 135.94, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.39, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.39, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.39, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.10000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.68, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.10000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.39, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 97.10000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.52, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.10000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.52, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 97.10000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.68, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 72.83, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.99, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.10000000000001, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CULTURE TYPING ID BLOOD PATH RESIST TYPE 6+TRGT 87154", "code_information": [ { "code": "87154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1308.36, "maximum": 3052.84, "gross_charge": 2180.6, "discounted_cash": 1635.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1308.36, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2180.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2180.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3052.84, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1962.54, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1962.54, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1962.54, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2180.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1744.48, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2180.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1962.54, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2180.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1561.31, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2180.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2616.72, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2180.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1744.48, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1635.45, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1661.62, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2180.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PROTIME 85610", "code_information": [ { "code": "85610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 25.74, "maximum": 60.06, "gross_charge": 42.9, "discounted_cash": 32.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.74, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 42.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 42.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 60.06, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.61, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.61, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.61, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.32, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.61, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 42.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.72, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.48, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 42.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.32, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 32.17, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.69, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE 87086", "code_information": [ { "code": "87086", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 48.42, "maximum": 112.98, "gross_charge": 80.7, "discounted_cash": 60.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.42, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 80.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 80.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 112.98, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 80.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.56, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 80.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 80.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.78, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 80.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.84, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 80.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.56, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 60.53, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.49, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 80.7, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GENERAL HEALTH PANEL", "code_information": [ { "code": "80050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 134.4, "maximum": 313.6, "gross_charge": 224.0, "discounted_cash": 168.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 313.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.38, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 168.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.69, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LACTATE (LACTIC ACID) 83605", "code_information": [ { "code": "83605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 45.6, "maximum": 106.4, "gross_charge": 76.0, "discounted_cash": 57.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 76.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 76.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 106.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 76.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 76.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 76.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.42, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 76.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 76.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 57.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.91, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 76.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MAGNESIUM 83735", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 32.4, "maximum": 75.6, "gross_charge": 54.0, "discounted_cash": 40.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 54.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 54.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 75.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 54.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 54.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 54.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.66, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 54.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 54.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 40.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 54.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTIBODY SCREEN RBC EACH SERUM TECH 86850", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 211.8, "maximum": 494.2, "gross_charge": 353.0, "discounted_cash": 264.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 353.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 353.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 494.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 353.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 353.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 353.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.75, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 353.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 423.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 353.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 264.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.99, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 353.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "INFECTIOUS AGENT NUCLEIC ACID GI 12-25 TARGETS 87507", "code_information": [ { "code": "87507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1737.0, "maximum": 4053.0, "gross_charge": 2895.0, "discounted_cash": 2171.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1737.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2895.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2895.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4053.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2605.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2605.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2605.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2895.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2316.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2895.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2605.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2895.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2072.82, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2895.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3474.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2895.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2316.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2171.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2205.99, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2895.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "C REACTIVE PROTEIN QUANT 86140", "code_information": [ { "code": "86140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.2, "maximum": 51.8, "gross_charge": 37.0, "discounted_cash": 27.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 51.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.49, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 27.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.19, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PROCALCITONIN (PCT) 84145", "code_information": [ { "code": "84145", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 113.4, "maximum": 264.6, "gross_charge": 189.0, "discounted_cash": 141.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 264.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.32, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 141.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.02, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DRUG SCR PRESUMP DIRECT OPTICAL OBS 80305", "code_information": [ { "code": "80305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.0, "maximum": 140.0, "gross_charge": 100.0, "discounted_cash": 75.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "URINALYSIS AUTO W/SCOPE 81001", "code_information": [ { "code": "81001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 13.2, "maximum": 30.8, "gross_charge": 22.0, "discounted_cash": 16.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 22.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 22.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 30.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 22.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 22.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 22.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.75, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 22.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 22.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 16.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.76, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 22.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ASSAY OF PSA TOTAL 84153", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 77.4, "maximum": 180.6, "gross_charge": 129.0, "discounted_cash": 96.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 180.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.36, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 96.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.3, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BLOOD COUNT COMPLETE AUTOMATED 85027", "code_information": [ { "code": "85027", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 27.0, "maximum": 63.0, "gross_charge": 45.0, "discounted_cash": 33.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 63.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.22, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 33.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.29, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MICROBE SUSCEPTIBLE MIC 87186", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 35.4, "maximum": 82.6, "gross_charge": 59.0, "discounted_cash": 44.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 82.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.24, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 44.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CREATININE OTHER SOURCE 82570", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.2, "maximum": 51.8, "gross_charge": 37.0, "discounted_cash": 27.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 51.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.49, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 27.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.19, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "AEROBIC DEFINITIVE ID 87077", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 34.8, "maximum": 81.2, "gross_charge": 58.0, "discounted_cash": 43.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 81.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.53, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 43.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ALBUMIN URINE MICROALBUMIN QUANT 82043", "code_information": [ { "code": "82043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 24.6, "maximum": 57.4, "gross_charge": 41.0, "discounted_cash": 30.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 57.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.36, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 30.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.24, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 82803", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 103.8, "maximum": 242.2, "gross_charge": 173.0, "discounted_cash": 129.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 173.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 173.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 242.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 173.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 173.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 173.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.87, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 173.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 173.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 129.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.83, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 173.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES 87040", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 43.2, "maximum": 100.8, "gross_charge": 72.0, "discounted_cash": 54.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 100.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.55, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 54.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.86, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "THROMBOPLASTIN TIME PARTIAL PLASMA WHOLE BLOOD (PTT) 85730", "code_information": [ { "code": "85730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 25.2, "maximum": 58.8, "gross_charge": 42.0, "discounted_cash": 31.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 58.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.07, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 31.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.0, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "VITAMIN D 25 HYDROXY 82306", "code_information": [ { "code": "82306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 154.2, "maximum": 359.8, "gross_charge": 257.0, "discounted_cash": 192.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 359.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.01, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 308.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 192.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.83, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ASSAY ALCOHOL ANY SPEC EXCEPT URINE & BREATH 82077", "code_information": [ { "code": "82077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.6, "maximum": 120.4, "gross_charge": 86.0, "discounted_cash": 64.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 120.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.58, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 64.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RENAL FUNCTION PANEL 80069", "code_information": [ { "code": "80069", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 37.2, "maximum": 86.8, "gross_charge": 62.0, "discounted_cash": 46.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 86.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.39, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 46.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.24, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ASSAY OF FREE THYROXINE 84439", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 36.6, "maximum": 85.4, "gross_charge": 61.0, "discounted_cash": 45.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 85.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.68, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 45.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ASSAY OF FERRITIN 82728", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 57.0, "maximum": 133.0, "gross_charge": 95.0, "discounted_cash": 71.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.02, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 71.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.39, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "FIBRIN DEGRADATION PRODUCTS D-DIMER QUANT 85379", "code_information": [ { "code": "85379", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 41.4, "maximum": 96.6, "gross_charge": 69.0, "discounted_cash": 51.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 96.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.4, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 51.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PSA SCREENING G0103", "code_information": [ { "code": "G0103", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 77.4, "maximum": 180.6, "gross_charge": 129.0, "discounted_cash": 96.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 180.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.36, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 96.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.3, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "T3 FREE 84481", "code_information": [ { "code": "84481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 81.0, "maximum": 189.0, "gross_charge": 135.0, "discounted_cash": 101.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.66, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 101.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CYANOCOBALAMIN VITAMIN B-12 82607", "code_information": [ { "code": "82607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 63.6, "maximum": 148.4, "gross_charge": 106.0, "discounted_cash": 79.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 148.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 79.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRSA PCR NASAL COLONIZATN87641", "code_information": [ { "code": "87641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 147.6, "maximum": 344.4, "gross_charge": 246.0, "discounted_cash": 184.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 344.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 184.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LIPASE 83690", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 29.4, "maximum": 68.6, "gross_charge": 49.0, "discounted_cash": 36.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 68.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.08, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 36.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE 87493", "code_information": [ { "code": "87493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 147.6, "maximum": 344.4, "gross_charge": 246.0, "discounted_cash": 184.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 344.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 184.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CDMR SARS-COV-2 COVID-19 AMP PRB 87635", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 106.8, "maximum": 249.2, "gross_charge": 178.0, "discounted_cash": 133.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 249.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.45, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 133.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.64, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IRON BINDING CAPACITY 83550", "code_information": [ { "code": "83550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 37.2, "maximum": 86.8, "gross_charge": 62.0, "discounted_cash": 46.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 86.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.39, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 46.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.24, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CDMR BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 82274", "code_information": [ { "code": "82274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 67.2, "maximum": 156.8, "gross_charge": 112.0, "discounted_cash": 84.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 156.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.19, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "INFLUENZA A B DIRECT 87804", "code_information": [ { "code": "87804", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 66.0, "maximum": 154.0, "gross_charge": 110.0, "discounted_cash": 82.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.76, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 82.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CREATININE BLOOD 82565", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.2, "maximum": 51.8, "gross_charge": 37.0, "discounted_cash": 27.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 51.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.49, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 27.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.19, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PTH INTACT 83970", "code_information": [ { "code": "83970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 174.0, "maximum": 406.0, "gross_charge": 290.0, "discounted_cash": 217.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 290.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 290.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 406.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 290.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 290.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 290.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.64, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 290.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 290.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 217.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.98, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 290.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IRON 83540", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 27.0, "maximum": 63.0, "gross_charge": 45.0, "discounted_cash": 33.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 63.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.22, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 33.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.29, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "URINALYSIS-DIPSTICK ONLY 81003", "code_information": [ { "code": "81003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.2, "maximum": 23.8, "gross_charge": 17.0, "discounted_cash": 12.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.17, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 12.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.95, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ARTERIAL PUNCTURE", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 159.0, "maximum": 371.0, "gross_charge": 265.0, "discounted_cash": 198.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 265.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 265.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 371.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 265.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 265.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 265.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.74, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 265.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 318.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 265.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 198.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.93, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 265.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HEPATIC FUNCTION PANEL 80076", "code_information": [ { "code": "80076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 34.8, "maximum": 81.2, "gross_charge": 58.0, "discounted_cash": 43.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 81.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.53, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 43.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "URINE PREGNANCY TEST 81025", "code_information": [ { "code": "81025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 34.8, "maximum": 81.2, "gross_charge": 58.0, "discounted_cash": 43.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 81.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.53, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 43.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CA 15-3 ANTIGEN 86300", "code_information": [ { "code": "86300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 87.6, "maximum": 204.4, "gross_charge": 146.0, "discounted_cash": 109.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 204.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.54, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 109.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.25, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TESTOSTERONE TOTAL MEASURED 84403.902", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 108.6, "maximum": 253.4, "gross_charge": 181.0, "discounted_cash": 135.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 253.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 135.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.92, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TESTOSTERONE FREE MEASURED 84402.901", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 106.8, "maximum": 249.2, "gross_charge": 178.0, "discounted_cash": 133.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 249.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.45, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 133.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.64, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TACROLIMUS 80197", "code_information": [ { "code": "80197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 57.6, "maximum": 134.4, "gross_charge": 96.0, "discounted_cash": 72.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 134.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.74, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ASSAY OF PHOSPHORUS INORGANIC 84100", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 20.4, "maximum": 47.6, "gross_charge": 34.0, "discounted_cash": 25.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 47.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 25.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.91, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HEPATITIS C ANTIBODY 86803", "code_information": [ { "code": "86803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.0, "maximum": 140.0, "gross_charge": 100.0, "discounted_cash": 75.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ESTRADIOL TOTAL 82670", "code_information": [ { "code": "82670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 117.6, "maximum": 274.4, "gross_charge": 196.0, "discounted_cash": 147.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 196.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 196.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 274.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 196.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 196.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 196.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.34, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 196.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 196.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 147.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.35, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 196.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "VANCOMYCIN PEK TRGH RNDM 80202", "code_information": [ { "code": "80202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 57.0, "maximum": 133.0, "gross_charge": 95.0, "discounted_cash": 71.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.02, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 71.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.39, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HIV-1 AG WHIV-1 & HIV-2 AB 87389/G0475", "code_information": [ { "code": "87389", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 97.8, "maximum": 228.2, "gross_charge": 163.0, "discounted_cash": 122.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 228.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.71, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 122.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.21, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GONADOTROPIN CHORIONIC HCG QUANTITATIVE 84702", "code_information": [ { "code": "84702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 63.6, "maximum": 148.4, "gross_charge": 106.0, "discounted_cash": 79.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 148.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 79.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SEDIMENTATION RATE RBC NON-AUTOMATED 85651", "code_information": [ { "code": "85651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 17.4, "maximum": 40.6, "gross_charge": 29.0, "discounted_cash": 21.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 40.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.76, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 21.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CULTURE: BACT OTHER 87070", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 36.6, "maximum": 85.4, "gross_charge": 61.0, "discounted_cash": 45.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 85.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.68, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 45.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SIROLIMUS (RAPAMUNE) 80195", "code_information": [ { "code": "80195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 57.6, "maximum": 134.4, "gross_charge": 96.0, "discounted_cash": 72.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 134.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.74, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "FOLATE 82746", "code_information": [ { "code": "82746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 61.8, "maximum": 144.2, "gross_charge": 103.0, "discounted_cash": 77.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 144.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.75, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 77.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.49, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ASSAY OF BLOOD/URIC ACID 84550", "code_information": [ { "code": "84550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 19.2, "maximum": 44.8, "gross_charge": 32.0, "discounted_cash": 24.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 44.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.91, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 24.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.38, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DHEA SULFATE 82627", "code_information": [ { "code": "82627", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 94.2, "maximum": 219.8, "gross_charge": 157.0, "discounted_cash": 117.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 157.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 157.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 219.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 157.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 157.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 157.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.41, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 157.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 157.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 117.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 157.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GONADOTROPIN FOLLICLE STIMULATING HORMONE (FSH) 83001", "code_information": [ { "code": "83001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 78.0, "maximum": 182.0, "gross_charge": 130.0, "discounted_cash": 97.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 182.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.08, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 97.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.06, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PROTEIN TOT UR 84156", "code_information": [ { "code": "84156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 15.0, "maximum": 35.0, "gross_charge": 25.0, "discounted_cash": 18.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.9, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 18.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.05, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ASSAY OF TESTOSTERONE TOTAL 84403", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 108.6, "maximum": 253.4, "gross_charge": 181.0, "discounted_cash": 135.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 253.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 135.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.92, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "COMPATIBILITY TEST EACH UNIT ELECTRONIC 86923", "code_information": [ { "code": "86923", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.8, "maximum": 53.2, "gross_charge": 38.0, "discounted_cash": 28.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 53.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.21, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 28.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BLOOD COUNT SMEAR MCRSCP W/MNL DIFRNTL WBC COUNT 85007", "code_information": [ { "code": "85007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 15.0, "maximum": 35.0, "gross_charge": 25.0, "discounted_cash": 18.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.9, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 18.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.05, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SMEAR PRIMARY SOURCE GRAM STAIN 87205", "code_information": [ { "code": "87205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 18.6, "maximum": 43.4, "gross_charge": 31.0, "discounted_cash": 23.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 43.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 23.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.62, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "JAK2 EXON 12-15 SEQUENCING SO 81270.900", "code_information": [ { "code": "81270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 409.8, "maximum": 956.2, "gross_charge": 683.0, "discounted_cash": 512.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 683.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 683.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 956.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 614.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 614.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 614.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 683.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 546.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 683.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 614.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 683.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 489.03, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 683.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 819.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 683.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 546.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 512.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 520.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 683.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PROLACTIN 84146", "code_information": [ { "code": "84146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 81.6, "maximum": 190.4, "gross_charge": 136.0, "discounted_cash": 102.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 190.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.38, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CYCLIC CITR PEP AB(CCP) 86200", "code_information": [ { "code": "86200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 81.0, "maximum": 189.0, "gross_charge": 135.0, "discounted_cash": 101.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.66, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 101.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DRUG SCREEN COLL FEE FOR LAB", "code_information": [ { "code": "99000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 28.2, "maximum": 65.8, "gross_charge": 47.0, "discounted_cash": 35.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 47.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 65.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 47.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 47.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 47.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.65, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 47.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 47.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 35.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 47.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SURGICAL PATH LEVEL IV 88305", "code_information": [ { "code": "88305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 130.2, "maximum": 303.8, "gross_charge": 217.0, "discounted_cash": 162.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 217.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 303.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 217.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 217.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 217.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.37, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 217.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 217.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 162.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.35, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 217.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CPK 82550", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 27.0, "maximum": 63.0, "gross_charge": 45.0, "discounted_cash": 33.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 63.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.22, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 33.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.29, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CULTURE: TYPING ANTISERU 87147", "code_information": [ { "code": "87147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.2, "maximum": 51.8, "gross_charge": 37.0, "discounted_cash": 27.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 51.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.49, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 27.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.19, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DIGOXIN 80162", "code_information": [ { "code": "80162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 70.2, "maximum": 163.8, "gross_charge": 117.0, "discounted_cash": 87.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 163.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.77, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 87.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CALCIUM TOTAL 82310", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.2, "maximum": 51.8, "gross_charge": 37.0, "discounted_cash": 27.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 51.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.49, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 27.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.19, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PROGESTERONE 84144", "code_information": [ { "code": "84144", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 87.6, "maximum": 204.4, "gross_charge": 146.0, "discounted_cash": 109.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 204.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.54, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 109.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.25, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "AMYLASE 82150", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 27.0, "maximum": 63.0, "gross_charge": 45.0, "discounted_cash": 33.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 63.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.22, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 33.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.29, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GONADOTROPIN LUTEINIZING HORMONE (LH) 83002", "code_information": [ { "code": "83002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 78.0, "maximum": 182.0, "gross_charge": 130.0, "discounted_cash": 97.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 182.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.08, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 97.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.06, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BLOOD TYPING SEROLOGIC ABO 86900", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 12.6, "maximum": 29.4, "gross_charge": 21.0, "discounted_cash": 15.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 15.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.0, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BLOOD TYPING SEROLOGIC RH (D) 86901", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 12.6, "maximum": 29.4, "gross_charge": 21.0, "discounted_cash": 15.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 15.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.0, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "INFECT AGNT NUCLEIC ACID DNA RNA CHLAMYDIA TRACH AMPLIF PROBE 87491", "code_information": [ { "code": "87491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 147.6, "maximum": 344.4, "gross_charge": 246.0, "discounted_cash": 184.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 344.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 184.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "INFECT AGNT NUCLEIC ACID DNA RNA NEISSERIA GONORRHOEAE AMPLIF PROBE 87591", "code_information": [ { "code": "87591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 147.6, "maximum": 344.4, "gross_charge": 246.0, "discounted_cash": 184.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 344.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 184.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CDMR THIOPURINE S-METHYLTRANSFERASE GENE ANLYS COM VAR", "code_information": [ { "code": "81241", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 290.4, "maximum": 677.6, "gross_charge": 484.0, "discounted_cash": 363.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 484.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 484.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 677.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 435.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 435.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 435.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 484.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 484.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 435.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 484.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 346.54, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 484.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 484.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 363.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.81, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 484.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "VITAMIN B1 (THIAMINE) 84425.900", "code_information": [ { "code": "84425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 88.8, "maximum": 207.2, "gross_charge": 148.0, "discounted_cash": 111.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 148.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 148.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 207.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 148.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 148.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 148.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.97, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 148.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 148.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 148.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IMMUNOGLOBULIN LIGHT CHAINS FREE EACH", "code_information": [ { "code": "83521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 27.6, "maximum": 64.4, "gross_charge": 46.0, "discounted_cash": 34.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 46.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 64.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 46.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 46.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 46.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.94, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 46.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 46.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 34.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.05, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 46.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTINUCLEAR ANTIBODY SCRE86038", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.0, "maximum": 119.0, "gross_charge": 85.0, "discounted_cash": 63.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "AMMONIA 82140", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 61.2, "maximum": 142.8, "gross_charge": 102.0, "discounted_cash": 76.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 142.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.03, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 76.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTITHYROID AB ANTI TPO 86376", "code_information": [ { "code": "86376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 61.2, "maximum": 142.8, "gross_charge": 102.0, "discounted_cash": 76.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 142.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.03, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 76.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PREALBUMIN 84134", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 59.4, "maximum": 138.6, "gross_charge": 99.0, "discounted_cash": 74.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 99.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 99.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 138.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 99.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 99.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 99.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.88, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 99.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 99.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 74.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.44, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 99.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EA 82784", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 39.0, "maximum": 91.0, "gross_charge": 65.0, "discounted_cash": 48.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 65.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 65.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 65.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 65.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 65.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.54, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 65.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 65.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 48.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 65.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TB TEST CELL MEDIATED IMMUNITY 86480", "code_information": [ { "code": "86480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 232.2, "maximum": 541.8, "gross_charge": 387.0, "discounted_cash": 290.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 387.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 387.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 541.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 387.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 387.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 387.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.09, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 387.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 387.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 290.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 294.89, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 387.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BLOOD COUNT HEMOGLOBIN 85018", "code_information": [ { "code": "85018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.2, "maximum": 23.8, "gross_charge": 17.0, "discounted_cash": 12.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.17, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 12.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.95, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CULTURE: BACT RESPITOR 87070", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 36.6, "maximum": 85.4, "gross_charge": 61.0, "discounted_cash": 45.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 85.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.68, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 45.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "INSURANCE DRAW FEE", "code_information": [ { "code": "36415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 13.8, "maximum": 32.2, "gross_charge": 23.0, "discounted_cash": 17.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 32.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.47, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 17.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TRANSFERASE ALANINE AMINO ALT SGPT 84460", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.8, "maximum": 53.2, "gross_charge": 38.0, "discounted_cash": 28.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 53.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.21, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 28.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "INSULIN LEVEL 83525", "code_information": [ { "code": "83525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 48.6, "maximum": 113.4, "gross_charge": 81.0, "discounted_cash": 60.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 113.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.0, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 60.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PATHOGENIC ORGANISM SCR 87081", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 27.0, "maximum": 63.0, "gross_charge": 45.0, "discounted_cash": 33.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 63.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.22, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 33.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.29, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS", "code_information": [ { "code": "86364", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 18.6, "maximum": 43.4, "gross_charge": 31.0, "discounted_cash": 23.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 43.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 23.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.62, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTIBODY RUBELLA 86762", "code_information": [ { "code": "86762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.6, "maximum": 141.4, "gross_charge": 101.0, "discounted_cash": 75.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 141.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.32, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 75.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HEPATITIS B DNA QUANTIFICATION 87517", "code_information": [ { "code": "87517", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 180.0, "maximum": 420.0, "gross_charge": 300.0, "discounted_cash": 225.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 420.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.8, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 225.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.6, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "INFECT AGNT DETECT NUC ACID HEP C QUANT 87522", "code_information": [ { "code": "87522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 180.0, "maximum": 420.0, "gross_charge": 300.0, "discounted_cash": 225.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 420.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.8, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 225.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.6, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "INFECT AGNT ATGN DETECT IA HEPATITIS B SURFACE ANTIGEN 87340", "code_information": [ { "code": "87340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 42.0, "maximum": 98.0, "gross_charge": 70.0, "discounted_cash": 52.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 98.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 52.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CALPROTECTIN 83993", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 166.8, "maximum": 389.2, "gross_charge": 278.0, "discounted_cash": 208.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 278.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 278.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 389.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 278.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 222.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 278.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 278.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 199.05, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 278.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 333.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 278.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 222.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 208.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.84, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 278.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ADRENOCORTICOTROPIC HORMONE ACTH SO 82024.900", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 162.6, "maximum": 379.4, "gross_charge": 271.0, "discounted_cash": 203.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 379.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 203.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.5, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ERYTHROPOIETIN 82668.001", "code_information": [ { "code": "82668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 79.8, "maximum": 186.2, "gross_charge": 133.0, "discounted_cash": 99.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 186.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.23, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 99.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.35, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CULTURE STOOL ADD PATHGN87046", "code_information": [ { "code": "87046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 39.6, "maximum": 92.4, "gross_charge": 66.0, "discounted_cash": 49.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 92.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.26, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 49.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.29, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ASSAY OF GLUTAMYLTRASE GAMMA GGT 82977", "code_information": [ { "code": "82977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 30.6, "maximum": 71.4, "gross_charge": 51.0, "discounted_cash": 38.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 71.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.52, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 38.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.86, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY TO ANY METHOD EACH 86235", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 76.2, "maximum": 177.8, "gross_charge": 127.0, "discounted_cash": 95.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 177.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 95.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MYCOPHENOLATE SO 80180.001", "code_information": [ { "code": "80180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 73.2, "maximum": 170.8, "gross_charge": 122.0, "discounted_cash": 91.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 122.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 122.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 170.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 122.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 122.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 122.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.35, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 122.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 122.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 91.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 122.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "METANEPHRINES FRACT 24 HR URINE 83835.901", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 72.0, "maximum": 168.0, "gross_charge": 120.0, "discounted_cash": 90.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 120.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 120.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 168.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 120.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 120.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 120.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.92, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 120.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 120.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.44, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 120.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "POTASSIUM SERUM 84132", "code_information": [ { "code": "84132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 19.8, "maximum": 46.2, "gross_charge": 33.0, "discounted_cash": 24.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.63, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 24.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "T3 REVERSE 84482.900", "code_information": [ { "code": "84482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 66.6, "maximum": 155.4, "gross_charge": 111.0, "discounted_cash": 83.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 155.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 83.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "EB VIRUS-EBNA 86664", "code_information": [ { "code": "86664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 61.8, "maximum": 144.2, "gross_charge": 103.0, "discounted_cash": 77.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 144.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.75, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 77.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.49, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CARBAMAZEPINE (TEGRETOL) 80156", "code_information": [ { "code": "80156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 61.2, "maximum": 142.8, "gross_charge": 102.0, "discounted_cash": 76.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 142.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.03, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 76.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "H PYLORI AG STOOL 87338", "code_information": [ { "code": "87338", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.0, "maximum": 140.0, "gross_charge": 100.0, "discounted_cash": 75.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "VITAMIN B6 84207.900", "code_information": [ { "code": "84207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 118.2, "maximum": 275.8, "gross_charge": 197.0, "discounted_cash": 147.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 275.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.05, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 147.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TREPONEMA PALLIDUM 86780", "code_information": [ { "code": "86780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 55.8, "maximum": 130.2, "gross_charge": 93.0, "discounted_cash": 69.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 130.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.59, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 69.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTIBODY MUMPS 86735", "code_information": [ { "code": "86735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 55.2, "maximum": 128.8, "gross_charge": 92.0, "discounted_cash": 69.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 128.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.87, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTIBODY RUBEOLA 86765", "code_information": [ { "code": "86765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 54.6, "maximum": 127.4, "gross_charge": 91.0, "discounted_cash": 68.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 127.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.16, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 68.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LACTATE DEHYDROGENASE (LD) (LDH) 83615", "code_information": [ { "code": "83615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 25.8, "maximum": 60.2, "gross_charge": 43.0, "discounted_cash": 32.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 43.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 43.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 60.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 43.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 43.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 43.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.79, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 43.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 43.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 32.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 43.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "COMPLEMENT ANTIGEN EA 86160", "code_information": [ { "code": "86160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.0, "maximum": 119.0, "gross_charge": 85.0, "discounted_cash": 63.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "YEAST SUSCEPTIBILITY 87186.901", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 99.0, "maximum": 231.0, "gross_charge": 165.0, "discounted_cash": 123.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 231.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 123.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.73, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SHIGA-LIKE TOXIN 87427", "code_information": [ { "code": "87427", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 48.0, "maximum": 112.0, "gross_charge": 80.0, "discounted_cash": 60.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 80.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 80.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 80.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 80.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 80.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.28, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 80.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 80.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 60.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 80.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ELECTROPHORESIS SER 84165", "code_information": [ { "code": "84165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 45.0, "maximum": 105.0, "gross_charge": 75.0, "discounted_cash": 56.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.7, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 56.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CRYSTAL ID LIGHT MICROSCOPY BODY FLUID EXCPT URINE 89060", "code_information": [ { "code": "89060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 30.0, "maximum": 70.0, "gross_charge": 50.0, "discounted_cash": 37.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.8, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 37.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DOT URINE AUTO DIPSTICK 81003", "code_information": [ { "code": "81003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 12.6, "maximum": 29.4, "gross_charge": 21.0, "discounted_cash": 15.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 15.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.0, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ASSAY OF C PEPTIDE 84681", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 87.6, "maximum": 204.4, "gross_charge": 146.0, "discounted_cash": 109.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 204.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.54, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 109.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.25, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CA 19-9PANCREATIC CANCER86301", "code_information": [ { "code": "86301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 87.6, "maximum": 204.4, "gross_charge": 146.0, "discounted_cash": 109.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 204.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.54, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 109.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.25, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MONOSCREEN 86308", "code_information": [ { "code": "86308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.2, "maximum": 51.8, "gross_charge": 37.0, "discounted_cash": 27.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 51.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.49, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 27.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.19, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OSMOLALITY URINE 83935", "code_information": [ { "code": "83935", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 28.8, "maximum": 67.2, "gross_charge": 48.0, "discounted_cash": 36.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 67.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.37, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 36.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BENZODIAZEPINES 13 OR MORE 80347.903", "code_information": [ { "code": "80347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 85.2, "maximum": 198.8, "gross_charge": 142.0, "discounted_cash": 106.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 198.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.67, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 106.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OSMOLALITY FLUID 83930", "code_information": [ { "code": "83930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 28.2, "maximum": 65.8, "gross_charge": 47.0, "discounted_cash": 35.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 47.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 65.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 47.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 47.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 47.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.65, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 47.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 47.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 35.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 47.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANA TITER 86039", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 84.6, "maximum": 197.4, "gross_charge": 141.0, "discounted_cash": 105.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 197.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.96, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 105.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.44, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LEVETIRACETAM 80177", "code_information": [ { "code": "80177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 84.0, "maximum": 196.0, "gross_charge": 140.0, "discounted_cash": 105.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 196.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.24, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.68, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BILIRUBIN TOTAL 82247", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 21.0, "maximum": 49.0, "gross_charge": 35.0, "discounted_cash": 26.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.06, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 26.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BILIRUBIN DIRECT 82248", "code_information": [ { "code": "82248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 21.0, "maximum": 49.0, "gross_charge": 35.0, "discounted_cash": 26.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.06, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 26.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CULTURE: STOOL SAL SHIG 87045", "code_information": [ { "code": "87045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 39.6, "maximum": 92.4, "gross_charge": 66.0, "discounted_cash": 49.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 92.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.26, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 49.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.29, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CULTURE ANAEROBIC 87075", "code_information": [ { "code": "87075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 39.6, "maximum": 92.4, "gross_charge": 66.0, "discounted_cash": 49.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 92.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.26, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 49.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.29, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTI SCL70 86235", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 76.2, "maximum": 177.8, "gross_charge": 127.0, "discounted_cash": 95.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 177.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 95.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "JO-1 AB 86235", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 76.2, "maximum": 177.8, "gross_charge": 127.0, "discounted_cash": 95.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 177.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 95.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RNP AB IGG 86235", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 76.2, "maximum": 177.8, "gross_charge": 127.0, "discounted_cash": 95.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 177.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 95.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SM AB IGG 86235", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 76.2, "maximum": 177.8, "gross_charge": 127.0, "discounted_cash": 95.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 177.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 95.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HERPES SMPLX VIR 2 IGG 86696", "code_information": [ { "code": "86696", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 30.0, "maximum": 70.0, "gross_charge": 50.0, "discounted_cash": 37.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.8, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 37.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 50.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ASSAY OF ANTI MULLERIAN HORMONE AMH 82166.900", "code_information": [ { "code": "82166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 72.6, "maximum": 169.4, "gross_charge": 121.0, "discounted_cash": 90.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 169.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.64, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 90.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RA FACTOR QUANT 86431", "code_information": [ { "code": "86431", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 24.0, "maximum": 56.0, "gross_charge": 40.0, "discounted_cash": 30.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 40.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 56.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 40.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 40.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 40.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.64, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 40.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 40.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 40.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CORTISOL TOTAL 82533", "code_information": [ { "code": "82533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 69.0, "maximum": 161.0, "gross_charge": 115.0, "discounted_cash": 86.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 161.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.34, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 86.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HANDLING OTHER KITS", "code_information": [ { "code": "99000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 13.8, "maximum": 32.2, "gross_charge": 23.0, "discounted_cash": 17.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 32.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.47, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 17.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BETA 2 MICROGLOBULIN 82232", "code_information": [ { "code": "82232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.4, "maximum": 159.6, "gross_charge": 114.0, "discounted_cash": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 85.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IMMUNOASSAY ANALYTE QUANTITATIVE NOT OTHERWISE SPECIFIED SO 83520.902", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.4, "maximum": 159.6, "gross_charge": 114.0, "discounted_cash": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 85.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTIBODY WEST NILE VIRUS IGM 86788", "code_information": [ { "code": "86788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.4, "maximum": 159.6, "gross_charge": 114.0, "discounted_cash": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 85.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PRIMIDONE (MYSOLINE) SO 80188.001", "code_information": [ { "code": "80188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 67.2, "maximum": 156.8, "gross_charge": 112.0, "discounted_cash": 84.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 156.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.19, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "THYROGLOBULIN 84432", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 67.2, "maximum": 156.8, "gross_charge": 112.0, "discounted_cash": 84.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 156.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.19, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "THYROGLOBULIN AB 86800", "code_information": [ { "code": "86800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 66.6, "maximum": 155.4, "gross_charge": 111.0, "discounted_cash": 83.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 155.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 83.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 111.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "AST 84450", "code_information": [ { "code": "84450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.2, "maximum": 51.8, "gross_charge": 37.0, "discounted_cash": 27.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 51.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.49, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 27.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.19, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PHENOBARB WITH PRIMIDONE SO 80184.006", "code_information": [ { "code": "80184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.6, "maximum": 141.4, "gross_charge": 101.0, "discounted_cash": 75.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 141.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.32, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 75.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTI DNA DBL STRAND AB 86225", "code_information": [ { "code": "86225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 57.6, "maximum": 134.4, "gross_charge": 96.0, "discounted_cash": 72.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 134.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.74, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL 80164", "code_information": [ { "code": "80164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 57.0, "maximum": 133.0, "gross_charge": 95.0, "discounted_cash": 71.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.02, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 71.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.39, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PHENYTOIN TOTAL 80185", "code_information": [ { "code": "80185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 55.8, "maximum": 130.2, "gross_charge": 93.0, "discounted_cash": 69.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 130.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.59, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 69.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CRYPTOSPORIDIUM AG STOOL 87328", "code_information": [ { "code": "87328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 55.2, "maximum": 128.8, "gross_charge": 92.0, "discounted_cash": 69.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 128.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.87, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "C-REACTIVE PROTEIN HISEN 86141", "code_information": [ { "code": "86141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 54.6, "maximum": 127.4, "gross_charge": 91.0, "discounted_cash": 68.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 127.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.16, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 68.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TRANSFERRIN 84466", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 54.0, "maximum": 126.0, "gross_charge": 90.0, "discounted_cash": 67.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.44, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 67.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HEPATITIS B CORE ANTIBODY HBCAB TOTAL 86704", "code_information": [ { "code": "86704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.0, "maximum": 119.0, "gross_charge": 85.0, "discounted_cash": 63.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GIARDIA LAMBLIA AG FECES 87329", "code_information": [ { "code": "87329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.0, "maximum": 119.0, "gross_charge": 85.0, "discounted_cash": 63.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BLOOD COUNT HEMATOCRIT 85014", "code_information": [ { "code": "85014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.2, "maximum": 23.8, "gross_charge": 17.0, "discounted_cash": 12.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.17, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 12.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.95, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HERPES SIMPLX VIR1 IGG 86695", "code_information": [ { "code": "86695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 21.0, "maximum": 49.0, "gross_charge": 35.0, "discounted_cash": 26.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.06, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 26.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SMOOTH MUSCLE AB SCREEN SERUM 86015.900", "code_information": [ { "code": "86015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 49.2, "maximum": 114.8, "gross_charge": 82.0, "discounted_cash": 61.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 114.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.71, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 61.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CATECHOLAMINES FRACTIONATED 82384.900", "code_information": [ { "code": "82384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 48.0, "maximum": 112.0, "gross_charge": 80.0, "discounted_cash": 60.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 80.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 80.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 80.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 80.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 80.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.28, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 80.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 80.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 60.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 80.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HEPATITIS B SURFACE ANTIBODY (HBSAB) 86706", "code_information": [ { "code": "86706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 45.0, "maximum": 105.0, "gross_charge": 75.0, "discounted_cash": 56.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.7, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 56.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ALBUMIN SERUM 82040", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 21.0, "maximum": 49.0, "gross_charge": 35.0, "discounted_cash": 26.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.06, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 26.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SODIUM URINE 84300", "code_information": [ { "code": "84300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 20.4, "maximum": 47.6, "gross_charge": 34.0, "discounted_cash": 25.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 47.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 25.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.91, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "KETONE BODIES SERUM QUANTITATIVE 82010", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 34.8, "maximum": 81.2, "gross_charge": 58.0, "discounted_cash": 43.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 81.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.53, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 43.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GLUCOSE QUANT BLOOD (EXCEPT REAGENT STRIP) 82947", "code_information": [ { "code": "82947", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 17.4, "maximum": 40.6, "gross_charge": 29.0, "discounted_cash": 21.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 40.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.76, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 21.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTISTREPTOLYSIN O TITR 86060", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 30.6, "maximum": 71.4, "gross_charge": 51.0, "discounted_cash": 38.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 71.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.52, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 38.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.86, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CALCIUM URINE QUANTITATIVE TIMED SPECIMEN 82340", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 25.2, "maximum": 58.8, "gross_charge": 42.0, "discounted_cash": 31.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 58.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.07, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 31.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.0, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PHOSPHATASE ALKALINE 84075", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.2, "maximum": 51.8, "gross_charge": 37.0, "discounted_cash": 27.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 51.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.49, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 27.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.19, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GLUCOSE POST GLUCOSE DOSE 82950", "code_information": [ { "code": "82950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 20.4, "maximum": 47.6, "gross_charge": 34.0, "discounted_cash": 25.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 47.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 25.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.91, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SODIUM SERUM 84295", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 20.4, "maximum": 47.6, "gross_charge": 34.0, "discounted_cash": 25.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 47.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 25.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.91, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL 86592", "code_information": [ { "code": "86592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 18.6, "maximum": 43.4, "gross_charge": 31.0, "discounted_cash": 23.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 43.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 23.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.62, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "UREA NITROGEN QUANTITATIVE 84520", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 17.4, "maximum": 40.6, "gross_charge": 29.0, "discounted_cash": 21.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 40.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.76, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 21.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IDENTIFICATION AEROBIC 87077.002 SO", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 16.8, "maximum": 39.2, "gross_charge": 28.0, "discounted_cash": 21.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 39.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.05, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "URINALYSIS MICRO 81015", "code_information": [ { "code": "81015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 12.6, "maximum": 29.4, "gross_charge": 21.0, "discounted_cash": 15.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 15.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.0, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CAPILLARY COLLECTION 36416", "code_information": [ { "code": "36416", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 11.4, "maximum": 26.6, "gross_charge": 19.0, "discounted_cash": 14.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 14.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BLOOD COUNT RETICULOCYTES AUTO W1+ CELL PARAM DIR MEAS 85046", "code_information": [ { "code": "85046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.0, "maximum": 21.0, "gross_charge": 15.0, "discounted_cash": 11.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 15.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 15.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 15.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 15.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.74, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 15.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 15.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 11.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.43, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 15.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "VEN BLD COLLECTION IVAD 36591", "code_information": [ { "code": "36591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 114.0, "maximum": 266.0, "gross_charge": 190.0, "discounted_cash": 142.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 266.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 142.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "VEN BLD COLLECTION PICC 36592", "code_information": [ { "code": "36592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 118.2, "maximum": 275.8, "gross_charge": 197.0, "discounted_cash": 147.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 275.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.05, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 147.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ELECTROLYTE PANEL 80051", "code_information": [ { "code": "80051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 29.4, "maximum": 68.6, "gross_charge": 49.0, "discounted_cash": 36.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 68.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.08, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 36.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CYCLOSPORINE 80158", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 75.6, "maximum": 176.4, "gross_charge": 126.0, "discounted_cash": 94.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 176.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.22, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 94.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.01, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GENTAMICIN PEK TRGH RANDM80170", "code_information": [ { "code": "80170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 69.0, "maximum": 161.0, "gross_charge": 115.0, "discounted_cash": 86.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 161.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.34, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 86.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LAMOTRIGINE 80175.900", "code_information": [ { "code": "80175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 55.8, "maximum": 130.2, "gross_charge": 93.0, "discounted_cash": 69.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 130.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.59, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 69.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LITHIUM 80178", "code_information": [ { "code": "80178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 28.8, "maximum": 67.2, "gross_charge": 48.0, "discounted_cash": 36.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 67.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.37, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 36.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OXCARBAZEPINE SO 80183.001", "code_information": [ { "code": "80183", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 70.2, "maximum": 163.8, "gross_charge": 117.0, "discounted_cash": 87.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 163.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.77, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 87.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PHENOBARBITOL 80184", "code_information": [ { "code": "80184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.6, "maximum": 141.4, "gross_charge": 101.0, "discounted_cash": 75.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 141.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.32, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 75.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "THEOPHYLLINE 80198", "code_information": [ { "code": "80198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.0, "maximum": 140.0, "gross_charge": 100.0, "discounted_cash": 75.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TOBRAMYCIN PEK TRGH RNDM 80200", "code_information": [ { "code": "80200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.4, "maximum": 159.6, "gross_charge": 114.0, "discounted_cash": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 85.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TOPIRAMATE (TOPAMAX) SO 80201.001", "code_information": [ { "code": "80201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 50.4, "maximum": 117.6, "gross_charge": 84.0, "discounted_cash": 63.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.01, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ETHYLENE GLYCOL 80320 G0480", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.6, "maximum": 120.4, "gross_charge": 86.0, "discounted_cash": 64.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 120.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.58, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 64.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "NICOTINE 80323 G0480", "code_information": [ { "code": "80323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 18.0, "maximum": 42.0, "gross_charge": 30.0, "discounted_cash": 22.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 22.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.86, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 30.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "AMPHETAMINE 80324 G0480", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 174.0, "maximum": 406.0, "gross_charge": 290.0, "discounted_cash": 217.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 290.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 290.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 406.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 290.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 290.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 290.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.64, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 290.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 290.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 217.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.98, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 290.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DRUG SCREEN QUANT AMPHETAMINES 3 OR 4 80325.900 G0480", "code_information": [ { "code": "80325", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 67.2, "maximum": 156.8, "gross_charge": 112.0, "discounted_cash": 84.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 156.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.19, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BARBITURATES CONFIRM BLOOD LO 80345.901", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 49.2, "maximum": 114.8, "gross_charge": 82.0, "discounted_cash": 61.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 114.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.71, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 61.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BENZODIAXPINE 1-12 80346 G0480", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 86.4, "maximum": 201.6, "gross_charge": 144.0, "discounted_cash": 108.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 201.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.1, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 108.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.73, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BUPRENORPINE /NORBUPRENORPHINE 80348.005 G0480", "code_information": [ { "code": "80348", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 86.4, "maximum": 201.6, "gross_charge": 144.0, "discounted_cash": 108.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 201.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.1, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 108.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.73, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OPIATES CONFIRM BLOOD LO 80356.901", "code_information": [ { "code": "80356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.6, "maximum": 141.4, "gross_charge": 101.0, "discounted_cash": 75.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 141.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.32, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 75.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LO PAINO METHADONE CONFIRMATION SO 80358.004 G0480", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 71.4, "maximum": 166.6, "gross_charge": 119.0, "discounted_cash": 89.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 166.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.2, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 89.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.68, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "METHYLENEDIOXYAMPHETAMINE 80359 G0480", "code_information": [ { "code": "80359", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 82.8, "maximum": 193.2, "gross_charge": 138.0, "discounted_cash": 103.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 193.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.81, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 103.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.16, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RITALIN (METHYLPHENIDAT) SO 80360.002 G0480", "code_information": [ { "code": "80360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 82.8, "maximum": 193.2, "gross_charge": 138.0, "discounted_cash": 103.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 193.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.81, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 103.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.16, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OPIATES 1 OR MORE 80361.902 G0480", "code_information": [ { "code": "80361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 85.2, "maximum": 198.8, "gross_charge": 142.0, "discounted_cash": 106.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 198.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.67, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 106.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OPIATES CONFIRM BLOOD LO 80361.900", "code_information": [ { "code": "80361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.6, "maximum": 141.4, "gross_charge": 101.0, "discounted_cash": 75.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 141.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.32, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 75.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OPIOIDS & OPIATE ANALOG 1 OR 2 80362.903 G0480", "code_information": [ { "code": "80362", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 63.0, "maximum": 147.0, "gross_charge": 105.0, "discounted_cash": 78.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 147.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.18, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 78.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.01, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OXYCODONE 80365.902 G0480", "code_information": [ { "code": "80365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 85.2, "maximum": 198.8, "gross_charge": 142.0, "discounted_cash": 106.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 198.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.67, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 106.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PAINO OXYCODONE CONFIRM 80365 G0480", "code_information": [ { "code": "80365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 105.0, "maximum": 245.0, "gross_charge": 175.0, "discounted_cash": 131.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.3, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 131.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.35, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OXYCODONES CONFIRM BLOOD LO SO 80365.900", "code_information": [ { "code": "80365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.6, "maximum": 141.4, "gross_charge": 101.0, "discounted_cash": 75.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 141.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.32, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 75.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TRAMADOL AND METABOLITE, URINE 80373 G0480", "code_information": [ { "code": "80373", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 85.2, "maximum": 198.8, "gross_charge": 142.0, "discounted_cash": 106.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 198.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.67, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 106.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CLINITEST DIPSTICK TABLET81002", "code_information": [ { "code": "81002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 13.8, "maximum": 32.2, "gross_charge": 23.0, "discounted_cash": 17.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 32.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.47, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 17.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "URINE AUTO NO MICRO SGL ANALYT", "code_information": [ { "code": "81003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.2, "maximum": 23.8, "gross_charge": 17.0, "discounted_cash": 12.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.17, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 12.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.95, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 17.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "URINE VOLUME MEASURE 81050", "code_information": [ { "code": "81050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 14.4, "maximum": 33.6, "gross_charge": 24.0, "discounted_cash": 18.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 24.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 33.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 24.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 24.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 24.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.18, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 24.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 24.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 18.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.29, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 24.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BCR ABL MRNA PCR 81206.901", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 662.4, "maximum": 1545.6, "gross_charge": 1104.0, "discounted_cash": 828.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 662.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1104.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1104.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1545.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1104.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 883.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1104.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1104.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 790.46, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1104.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1324.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1104.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 883.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 828.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 841.25, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1104.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CDMR PROTHROMBIN G20210A MUTATION 81240.001", "code_information": [ { "code": "81240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 259.8, "maximum": 606.2, "gross_charge": 433.0, "discounted_cash": 324.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 433.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 433.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 606.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 433.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 346.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 433.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 433.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 310.03, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 433.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 519.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 433.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 346.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 324.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 329.95, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 433.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HUNTINGTONS DISEASE 81271.900", "code_information": [ { "code": "81271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 542.4, "maximum": 1265.6, "gross_charge": 904.0, "discounted_cash": 678.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 904.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 904.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1265.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 813.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 813.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 813.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 904.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 723.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 904.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 813.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 904.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 647.26, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 904.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1084.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 904.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 723.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 678.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 688.85, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 904.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ACYLCARNITINES QUANT EA SPEC SO 82017.900", "code_information": [ { "code": "82017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 219.6, "maximum": 512.4, "gross_charge": 366.0, "discounted_cash": 274.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 219.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 366.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 366.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 512.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 329.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 329.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 329.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 366.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 292.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 366.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 329.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 366.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 262.06, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 366.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 439.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 366.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 292.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 274.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.89, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 366.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ALDOLASE SO 82085.900", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 41.4, "maximum": 96.6, "gross_charge": 69.0, "discounted_cash": 51.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 96.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.4, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 51.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ALDOSTERONE 24 HR URINE SO 82088.900", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 172.2, "maximum": 401.8, "gross_charge": 287.0, "discounted_cash": 215.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 401.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 229.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.49, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 229.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 215.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 218.69, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ALDOSTERONE SO 82088.901", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 171.6, "maximum": 400.4, "gross_charge": 286.0, "discounted_cash": 214.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 286.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 286.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 400.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 286.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 286.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 286.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.78, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 286.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 343.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 286.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 214.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.93, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 286.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ALDOSTERONE SERUM SO 82088.902", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 172.2, "maximum": 401.8, "gross_charge": 287.0, "discounted_cash": 215.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 401.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 229.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.49, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 229.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 215.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 218.69, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ALDOSTERONE ACT RATIO 82088.903", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 172.2, "maximum": 401.8, "gross_charge": 287.0, "discounted_cash": 215.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 401.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 229.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.49, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 229.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 215.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 218.69, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ALPHA-1-ANTITRYP TOTAL 82103", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 56.4, "maximum": 131.6, "gross_charge": 94.0, "discounted_cash": 70.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 131.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.3, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 70.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ALPHA-1-ANTITRYP SO 82103.902", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 56.4, "maximum": 131.6, "gross_charge": 94.0, "discounted_cash": 70.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 131.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.3, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 70.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "A1AT PHENOTYPE SO 82104.901", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 57.0, "maximum": 133.0, "gross_charge": 95.0, "discounted_cash": 71.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.02, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 71.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.39, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ALPHA-FETOPROTEIN SERUM 82105", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 71.4, "maximum": 166.6, "gross_charge": 119.0, "discounted_cash": 89.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 166.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.2, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 89.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.68, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "AMINO ACIDS QUANT 6 OR MORE SO 82139.900", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 91.8, "maximum": 214.2, "gross_charge": 153.0, "discounted_cash": 114.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 153.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 153.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 214.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 153.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 153.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 153.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.55, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 153.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 153.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 114.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.59, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 153.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANDROSTENEDIONE 82157.900", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 123.0, "maximum": 287.0, "gross_charge": 205.0, "discounted_cash": 153.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 205.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 205.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 205.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 205.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 205.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.78, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 205.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 205.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 153.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.21, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 205.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANGIOTENSIN I ENZYME TEST 82164", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 61.2, "maximum": 142.8, "gross_charge": 102.0, "discounted_cash": 76.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 142.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.03, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 76.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ARSENIC BLOOD BY ATOM ABS SO 82175.901", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 80.4, "maximum": 187.6, "gross_charge": 134.0, "discounted_cash": 100.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 187.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.94, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 100.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OCCULT BLOOD OTHER SOURCES 82271", "code_information": [ { "code": "82271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 21.0, "maximum": 49.0, "gross_charge": 35.0, "discounted_cash": 26.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.06, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 26.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CADMIUM URINE RANDOM 82300.905", "code_information": [ { "code": "82300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 97.8, "maximum": 228.2, "gross_charge": 163.0, "discounted_cash": 122.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 228.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.71, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 122.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.21, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CALCIUM IONIZED 82330", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 57.6, "maximum": 134.4, "gross_charge": 96.0, "discounted_cash": 72.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 134.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.74, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CARBOXYHEMOGLOBIN QUANTITATIVE 82375", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 50.4, "maximum": 117.6, "gross_charge": 84.0, "discounted_cash": 63.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.01, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CARCINOEMBRYONIC ANTIGEN (CEA) 82378", "code_information": [ { "code": "82378", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 80.4, "maximum": 187.6, "gross_charge": 134.0, "discounted_cash": 100.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 187.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.94, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 100.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CARNITINE FREE & TOTAL 82379.900", "code_information": [ { "code": "82379", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.4, "maximum": 159.6, "gross_charge": 114.0, "discounted_cash": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 85.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CERULOPLASMIN 82390", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 45.0, "maximum": 105.0, "gross_charge": 75.0, "discounted_cash": 56.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.7, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 56.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CHLORIDE URINE 82436", "code_information": [ { "code": "82436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23.4, "maximum": 54.6, "gross_charge": 39.0, "discounted_cash": 29.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 54.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 29.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CHLORIDE OTHER SOURCE 82438", "code_information": [ { "code": "82438", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 21.0, "maximum": 49.0, "gross_charge": 35.0, "discounted_cash": 26.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.06, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 26.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CHOLESTEROL SERUM WHOLE BLOOD TOTAL 82465", "code_information": [ { "code": "82465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 18.6, "maximum": 43.4, "gross_charge": 31.0, "discounted_cash": 23.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 43.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 23.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.62, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CHROMIUM BLOOD 82495.900", "code_information": [ { "code": "82495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 85.8, "maximum": 200.2, "gross_charge": 143.0, "discounted_cash": 107.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 200.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.39, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 107.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.97, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CITRIC ACID URINE 82507.902", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 117.0, "maximum": 273.0, "gross_charge": 195.0, "discounted_cash": 146.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 195.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 195.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 273.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 195.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 195.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 195.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 195.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 195.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 146.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.59, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 195.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "COLLAGEN TYPE 1 C TLPTD 82523.901", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 79.2, "maximum": 184.8, "gross_charge": 132.0, "discounted_cash": 99.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 184.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.51, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 99.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "COPPER 82525", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 53.4, "maximum": 124.6, "gross_charge": 89.0, "discounted_cash": 66.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 89.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 89.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 124.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 89.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 89.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 89.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.72, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 89.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 89.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 66.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 89.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "COPPER SERUM PLASMA 82525.900", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 52.2, "maximum": 121.8, "gross_charge": 87.0, "discounted_cash": 65.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 121.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.29, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 65.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.29, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "COPPER 24 HOUR URINE 82525.901", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 52.2, "maximum": 121.8, "gross_charge": 87.0, "discounted_cash": 65.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 121.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.29, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 65.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.29, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CORTISOL FREE 24 HR URINE 82530.901", "code_information": [ { "code": "82530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 70.2, "maximum": 163.8, "gross_charge": 117.0, "discounted_cash": 87.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 163.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.77, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 87.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CORTISOL FREE SERUM OR PLASMA 82530.900", "code_information": [ { "code": "82530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 70.2, "maximum": 163.8, "gross_charge": 117.0, "discounted_cash": 87.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 163.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.77, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 87.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "COENZYME Q10 82542.909", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 95.4, "maximum": 222.6, "gross_charge": 159.0, "discounted_cash": 119.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 159.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 159.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 222.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 159.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 159.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 159.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.84, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 159.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 159.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 119.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.16, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 159.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CREATININE URINE 82570.911", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.2, "maximum": 51.8, "gross_charge": 37.0, "discounted_cash": 27.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 51.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.49, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 27.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.19, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CREATININE CLEARANCE 82575", "code_information": [ { "code": "82575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 39.6, "maximum": 92.4, "gross_charge": 66.0, "discounted_cash": 49.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 92.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.26, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 49.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.29, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 66.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CRYOGLOBULIN S.O. 82595", "code_information": [ { "code": "82595", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 26.4, "maximum": 61.6, "gross_charge": 44.0, "discounted_cash": 33.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 44.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 61.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 44.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 44.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 44.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 44.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 44.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 44.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DHEA 82626", "code_information": [ { "code": "82626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 106.2, "maximum": 247.8, "gross_charge": 177.0, "discounted_cash": 132.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 177.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 177.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 247.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 177.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 177.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 177.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.73, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 177.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 177.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 132.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 177.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DIHYDROXYVITAMIN D, 1,25 SO 82652.900", "code_information": [ { "code": "82652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 162.0, "maximum": 378.0, "gross_charge": 270.0, "discounted_cash": 202.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 270.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 270.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 378.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 270.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 270.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 270.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.32, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 270.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 270.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 202.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.74, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 270.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ESTRONE 82679", "code_information": [ { "code": "82679", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 105.0, "maximum": 245.0, "gross_charge": 175.0, "discounted_cash": 131.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.3, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 131.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.35, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "FECAL FAT QUANT 82710", "code_information": [ { "code": "82710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.4, "maximum": 159.6, "gross_charge": 114.0, "discounted_cash": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 85.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ASSAY OF GAMMAGLOBULIN IGE 82785", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 69.6, "maximum": 162.4, "gross_charge": 116.0, "discounted_cash": 87.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 116.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 116.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 162.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 116.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 116.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 116.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.06, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 116.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 116.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.39, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 116.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IGE IMMUNOGLOBULIN 82785", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 69.6, "maximum": 162.4, "gross_charge": 116.0, "discounted_cash": 87.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 116.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 116.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 162.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 116.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 116.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 116.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.06, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 116.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 116.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.39, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 116.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES 82787", "code_information": [ { "code": "82787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 33.0, "maximum": 77.0, "gross_charge": 55.0, "discounted_cash": 41.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 55.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 55.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 55.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 55.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 55.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.38, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 55.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 55.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 41.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.91, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 55.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GASTRIN 82941", "code_information": [ { "code": "82941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 80.4, "maximum": 187.6, "gross_charge": 134.0, "discounted_cash": 100.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 187.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.94, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 100.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GLUCAGON", "code_information": [ { "code": "82943", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 57.6, "maximum": 134.4, "gross_charge": 96.0, "discounted_cash": 72.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 134.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.74, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GLUCOSE BODY FLD 82945", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 17.4, "maximum": 40.6, "gross_charge": 29.0, "discounted_cash": 21.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 40.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.76, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 21.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GLUC TOL 3 SPEC & DOSE 82951", "code_information": [ { "code": "82951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 54.6, "maximum": 127.4, "gross_charge": 91.0, "discounted_cash": 68.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 127.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.16, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 68.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GLUC TOL ADD SPECS 82952", "code_information": [ { "code": "82952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 17.4, "maximum": 40.6, "gross_charge": 29.0, "discounted_cash": 21.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 40.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.76, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 21.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 29.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "G6PD 82955", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 41.4, "maximum": 96.6, "gross_charge": 69.0, "discounted_cash": 51.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 96.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.4, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 51.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GLUCOSE BLOOD BY GLUCOSE MONITORING DEVICE 82962", "code_information": [ { "code": "82962", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 13.8, "maximum": 32.2, "gross_charge": 23.0, "discounted_cash": 17.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 32.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.47, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 17.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "FSH W TANNER STAGES 83001.900", "code_information": [ { "code": "83001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 78.0, "maximum": 182.0, "gross_charge": 130.0, "discounted_cash": 97.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 182.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.08, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 97.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.06, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HAPTOGLOBIN QUANTITATIVE 83010", "code_information": [ { "code": "83010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 53.4, "maximum": 124.6, "gross_charge": 89.0, "discounted_cash": 66.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 89.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 89.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 124.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 89.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 89.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 89.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.72, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 89.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 89.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 66.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 89.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ASSAY OF HEMOGLOBIN PLASMA 83051", "code_information": [ { "code": "83051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 30.6, "maximum": 71.4, "gross_charge": 51.0, "discounted_cash": 38.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 71.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.52, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 38.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.86, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HOMOCYSTINE 83090", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 71.4, "maximum": 166.6, "gross_charge": 119.0, "discounted_cash": 89.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 166.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.2, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 89.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.68, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "5 HIAA 24 HR URINE 83497.902", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 54.6, "maximum": 127.4, "gross_charge": 91.0, "discounted_cash": 68.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 127.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.16, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 68.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DEAMID. GLIADIN AB IGA 83516.018", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 49.2, "maximum": 114.8, "gross_charge": 82.0, "discounted_cash": 61.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 114.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.71, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 61.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DEAMID. GLIADIN AB IGG 83516.019", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 49.2, "maximum": 114.8, "gross_charge": 82.0, "discounted_cash": 61.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 114.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.71, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 61.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "THYROTROPIN RECEPTOR AB SERUM 83520.916", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.4, "maximum": 159.6, "gross_charge": 114.0, "discounted_cash": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 85.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LDH ISOENZYME 83625", "code_information": [ { "code": "83625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 54.0, "maximum": 126.0, "gross_charge": 90.0, "discounted_cash": 67.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.44, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 67.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LACTOFERRIN FECAL QUAL 83630", "code_information": [ { "code": "83630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 82.8, "maximum": 193.2, "gross_charge": 138.0, "discounted_cash": 103.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 193.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.81, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 103.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.16, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LEAD 83655", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.0, "maximum": 119.0, "gross_charge": 85.0, "discounted_cash": 63.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL 83721", "code_information": [ { "code": "83721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 43.8, "maximum": 102.2, "gross_charge": 73.0, "discounted_cash": 54.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 102.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 54.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MAGNESIUM RBC SO 83735.900", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 27.0, "maximum": 63.0, "gross_charge": 45.0, "discounted_cash": 33.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 63.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.22, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 33.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.29, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MERCURY 83825 SO", "code_information": [ { "code": "83825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.4, "maximum": 159.6, "gross_charge": 114.0, "discounted_cash": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 85.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "METANEPHRINES FRACT FREE PLASMA 83835.900", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 153.0, "maximum": 357.0, "gross_charge": 255.0, "discounted_cash": 191.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 255.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 255.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 357.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 229.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 229.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 229.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 255.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 255.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 229.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 255.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.58, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 255.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 306.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 255.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 191.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.31, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 255.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MYGLOBIN 83874.900", "code_information": [ { "code": "83874", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 54.6, "maximum": 127.4, "gross_charge": 91.0, "discounted_cash": 68.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 127.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.16, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 68.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "NT-PRO B-TYPE NATRIURETIC PEPTIDE 83880.900", "code_information": [ { "code": "83880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 160.2, "maximum": 373.8, "gross_charge": 267.0, "discounted_cash": 200.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 267.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 267.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 373.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 267.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 267.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 267.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.17, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 267.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 267.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 200.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 267.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "NUCLEOTIDASE-5 83915", "code_information": [ { "code": "83915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 43.8, "maximum": 102.2, "gross_charge": 73.0, "discounted_cash": 54.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 102.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 54.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ORGANIC ACID SCR URINE 83919", "code_information": [ { "code": "83919", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 67.2, "maximum": 156.8, "gross_charge": 112.0, "discounted_cash": 84.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 156.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.19, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "METHYLMALONIC ACID QUANT SERUM 83921.900", "code_information": [ { "code": "83921", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 84.6, "maximum": 197.4, "gross_charge": 141.0, "discounted_cash": 105.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 197.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.96, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 105.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.44, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OXALATE 83945", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.4, "maximum": 12.6, "gross_charge": 9.0, "discounted_cash": 6.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 9.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 9.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 9.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 9.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.44, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 9.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 9.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 6.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 9.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PH NONBLOOD 83986", "code_information": [ { "code": "83986", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 15.0, "maximum": 35.0, "gross_charge": 25.0, "discounted_cash": 18.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.9, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 18.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.05, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PHENCYCLIDINE (CONF) URINE 83992 G0480", "code_information": [ { "code": "83992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.0, "maximum": 140.0, "gross_charge": 100.0, "discounted_cash": 75.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ALKALINE PHOSPHATASE FOR ISOENZYMES 84075.900", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.2, "maximum": 51.8, "gross_charge": 37.0, "discounted_cash": 27.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 51.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.49, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 27.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.19, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 37.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ALKALINE PHOS ISOENZYME 84080", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 61.8, "maximum": 144.2, "gross_charge": 103.0, "discounted_cash": 77.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 144.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.75, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 77.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.49, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PHOSPHORUS UR 84105", "code_information": [ { "code": "84105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23.4, "maximum": 54.6, "gross_charge": 39.0, "discounted_cash": 29.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 54.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 29.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "K: URINE 84133", "code_information": [ { "code": "84133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 19.2, "maximum": 44.8, "gross_charge": 32.0, "discounted_cash": 24.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 44.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.91, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 24.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.38, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MACROPROLACTIN 84146", "code_information": [ { "code": "84146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 81.6, "maximum": 190.4, "gross_charge": 136.0, "discounted_cash": 102.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 190.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.38, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PSA FREE 84154", "code_information": [ { "code": "84154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 76.2, "maximum": 177.8, "gross_charge": 127.0, "discounted_cash": 95.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 177.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 95.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PROTEIN EXCEPT REFRACTOMETRY SERUM PLASMA/WHL BLD 84155", "code_information": [ { "code": "84155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 15.0, "maximum": 35.0, "gross_charge": 25.0, "discounted_cash": 18.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.9, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 18.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.05, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 25.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PROTEIN TOT OTH 84157", "code_information": [ { "code": "84157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 16.8, "maximum": 39.2, "gross_charge": 28.0, "discounted_cash": 21.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 39.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.05, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PROTEIN ELECTRO URI 84166", "code_information": [ { "code": "84166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 75.0, "maximum": 175.0, "gross_charge": 125.0, "discounted_cash": 93.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 125.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 125.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 125.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 125.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 125.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.5, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 125.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 125.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 93.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.25, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 125.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PROINSULIN SO 84206.001", "code_information": [ { "code": "84206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 42.0, "maximum": 98.0, "gross_charge": 70.0, "discounted_cash": 52.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 98.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 52.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PYRUVIC ACID 84210", "code_information": [ { "code": "84210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 57.6, "maximum": 134.4, "gross_charge": 96.0, "discounted_cash": 72.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 134.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.74, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RECEPTOR SOLUBL TRNSFRN 84238", "code_information": [ { "code": "84238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 153.6, "maximum": 358.4, "gross_charge": 256.0, "discounted_cash": 192.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 256.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 256.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 358.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 256.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 256.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 256.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.3, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 256.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 256.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 192.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.07, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 256.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RENIN ACT RATIO 84244.900", "code_information": [ { "code": "84244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 92.4, "maximum": 215.6, "gross_charge": 154.0, "discounted_cash": 115.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 215.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.26, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 115.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.35, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RENIN 84244", "code_information": [ { "code": "84244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 92.4, "maximum": 215.6, "gross_charge": 154.0, "discounted_cash": 115.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 215.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.26, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 115.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.35, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SELENIUM BLOOD 84255", "code_information": [ { "code": "84255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 106.8, "maximum": 249.2, "gross_charge": 178.0, "discounted_cash": 133.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 249.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.45, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 133.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.64, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 178.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SEX HORMONE BIND GLOB 84270.001", "code_information": [ { "code": "84270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 91.2, "maximum": 212.8, "gross_charge": 152.0, "discounted_cash": 114.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 212.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.83, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "REDUCING SUBSTANCE, FECAL 84376", "code_information": [ { "code": "84376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23.4, "maximum": 54.6, "gross_charge": 39.0, "discounted_cash": 29.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 54.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 29.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TESTOSTERONE TOTAL 84403.900", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 108.6, "maximum": 253.4, "gross_charge": 181.0, "discounted_cash": 135.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 253.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 135.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.92, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 181.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TESTOSTERONE; BIOAVAILABLE, DIRECT MEASUREMENT 84410.900", "code_information": [ { "code": "84410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 208.8, "maximum": 487.2, "gross_charge": 348.0, "discounted_cash": 261.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 348.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 348.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 487.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 348.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 348.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 348.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.17, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 348.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 417.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 348.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 261.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 265.18, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 348.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "THYROGLOB FNA LYMPH NODE 84432", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 67.8, "maximum": 158.2, "gross_charge": 113.0, "discounted_cash": 84.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 113.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 113.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 158.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 113.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 113.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 113.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.91, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 113.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 113.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 84.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 113.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "T4 84436", "code_information": [ { "code": "84436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 29.4, "maximum": 68.6, "gross_charge": 49.0, "discounted_cash": 36.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 68.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.08, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 36.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "THYROID STIMULATING IMMUGLOBULIN 84445.900", "code_information": [ { "code": "84445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 214.2, "maximum": 499.8, "gross_charge": 357.0, "discounted_cash": 267.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 357.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 357.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 499.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 357.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 357.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 357.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.61, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 357.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 357.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 267.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 272.03, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 357.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TRIGLYCERIDES 84478", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 24.6, "maximum": 57.4, "gross_charge": 41.0, "discounted_cash": 30.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 57.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.36, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 30.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.24, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "T3 TOTAL (TRIIODOTHYRON) 84480", "code_information": [ { "code": "84480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.0, "maximum": 140.0, "gross_charge": 100.0, "discounted_cash": 75.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "UREA NITROGEN URINE 84540", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.8, "maximum": 53.2, "gross_charge": 38.0, "discounted_cash": 28.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 53.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.21, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 28.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "URIC ACID OTHER 84560", "code_information": [ { "code": "84560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 20.4, "maximum": 47.6, "gross_charge": 34.0, "discounted_cash": 25.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 47.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 25.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.91, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "VITAMIN K 84597", "code_information": [ { "code": "84597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 57.6, "maximum": 134.4, "gross_charge": 96.0, "discounted_cash": 72.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 134.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.74, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ZINC 84630.900", "code_information": [ { "code": "84630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 48.6, "maximum": 113.4, "gross_charge": 81.0, "discounted_cash": 60.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 113.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.0, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 60.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HCG QUAL 84703", "code_information": [ { "code": "84703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 11.4, "maximum": 26.6, "gross_charge": 19.0, "discounted_cash": 14.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 14.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BLOOD COUNT LEUKOCYTE (WBC) AUTOMATED 85048", "code_information": [ { "code": "85048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.8, "maximum": 25.2, "gross_charge": 18.0, "discounted_cash": 13.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 18.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 18.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 18.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 18.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.89, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 18.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 18.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 13.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 18.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BLOOD COUNT PLATELET AUTOMATED 85049", "code_information": [ { "code": "85049", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 19.2, "maximum": 44.8, "gross_charge": 32.0, "discounted_cash": 24.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 44.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.91, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 24.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.38, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 32.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CLOTTING FACTOR VIII (AHG) ONE STAGE 85240", "code_information": [ { "code": "85240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 72.6, "maximum": 169.4, "gross_charge": 121.0, "discounted_cash": 90.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 169.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.64, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 90.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT 85245", "code_information": [ { "code": "85245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 97.2, "maximum": 226.8, "gross_charge": 162.0, "discounted_cash": 121.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 162.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 162.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 226.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 162.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 162.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 162.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.99, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 162.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 162.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 121.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.44, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 162.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CLOTTING FACTOR VIII VW FACTOR ANTIGEN 85246.900", "code_information": [ { "code": "85246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 97.2, "maximum": 226.8, "gross_charge": 162.0, "discounted_cash": 121.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 162.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 162.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 226.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 162.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 162.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 162.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.99, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 162.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 162.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 121.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.44, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 162.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTITHROMBIN III ACTIVITY 85300", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 50.4, "maximum": 117.6, "gross_charge": 84.0, "discounted_cash": 63.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.01, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTITHROMBIN III ANTIGN SO 85301.900", "code_information": [ { "code": "85301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 45.0, "maximum": 105.0, "gross_charge": 75.0, "discounted_cash": 56.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.7, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 56.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PROTEIN C ANTIGEN 85302.902", "code_information": [ { "code": "85302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.0, "maximum": 119.0, "gross_charge": 85.0, "discounted_cash": 63.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CLOTTING INHIBITORS PROTEIN C ACTIVITY 85303", "code_information": [ { "code": "85303", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 58.2, "maximum": 135.8, "gross_charge": 97.0, "discounted_cash": 72.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 135.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.45, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 72.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.91, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CLOTTING INHIBITORS PROTEIN S FREE 85306", "code_information": [ { "code": "85306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 61.8, "maximum": 144.2, "gross_charge": 103.0, "discounted_cash": 77.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 144.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.75, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 77.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.49, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 103.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "FIBRINOGEN ACTIVITY 85384", "code_information": [ { "code": "85384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 38.4, "maximum": 89.6, "gross_charge": 64.0, "discounted_cash": 48.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 64.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 64.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 89.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 64.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 64.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 64.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.82, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 64.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 64.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 64.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PLATELET AGGREGATION IN VITRO EACH AGENT 85576", "code_information": [ { "code": "85576", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 99.0, "maximum": 231.0, "gross_charge": 165.0, "discounted_cash": 123.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 231.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 123.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.73, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PT INR FINGERSTICK-QW 85610", "code_information": [ { "code": "85610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 19.8, "maximum": 46.2, "gross_charge": 33.0, "discounted_cash": 24.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.63, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 24.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LUPUS ANTICOAG PANEL PT 85610.900", "code_information": [ { "code": "85610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 19.8, "maximum": 46.2, "gross_charge": 33.0, "discounted_cash": 24.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.63, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 24.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RUSSELL VIPER VENON TIME UNDILUTED 85612", "code_information": [ { "code": "85612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 73.2, "maximum": 170.8, "gross_charge": 122.0, "discounted_cash": 91.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 122.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 122.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 170.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 122.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 122.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 122.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.35, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 122.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 122.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 91.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 122.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RUSSELL VIPER VENOM TIME DILUTED 85613", "code_information": [ { "code": "85613", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 40.8, "maximum": 95.2, "gross_charge": 68.0, "discounted_cash": 51.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 95.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.69, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LUPUS ANTICOAG PANEL DRVV 85613.902", "code_information": [ { "code": "85613", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 40.8, "maximum": 95.2, "gross_charge": 68.0, "discounted_cash": 51.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 95.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.69, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 51.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 68.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "THROMBIN TIME PLASMA 85670", "code_information": [ { "code": "85670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 29.4, "maximum": 68.6, "gross_charge": 49.0, "discounted_cash": 36.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 68.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.08, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 36.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LUPUS ANTICOAG PANEL PTT 85730.900", "code_information": [ { "code": "85730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 25.2, "maximum": 58.8, "gross_charge": 42.0, "discounted_cash": 31.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 58.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.07, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 31.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.0, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH 86003", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 21.0, "maximum": 49.0, "gross_charge": 35.0, "discounted_cash": 26.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.06, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 26.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ALLERGEN ON PANEL 86003", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 21.0, "maximum": 49.0, "gross_charge": 35.0, "discounted_cash": 26.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.06, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 26.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 35.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTINEUTROPHIL CYTOPLASMIC ANTIBOTY SCREEN ANCA EA ANTIBODY", "code_information": [ { "code": "86036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.0, "maximum": 119.0, "gross_charge": 85.0, "discounted_cash": 63.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CONNECT TISSUE ANTINUCLEAR AB 86038.007", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.0, "maximum": 119.0, "gross_charge": 85.0, "discounted_cash": 63.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "AQUAPORIN-4 ANTIBODY NMO FLOW CYTOMETRY EACH SO 86053.900", "code_information": [ { "code": "86053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 50.4, "maximum": 117.6, "gross_charge": 84.0, "discounted_cash": 63.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.01, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BETA-2 GLYCOPROTEIN G M 86146", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 103.2, "maximum": 240.8, "gross_charge": 172.0, "discounted_cash": 129.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 240.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.15, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.06, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CARDIOLIPIN IGA IGG&IGM AB 86147.901", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 103.2, "maximum": 240.8, "gross_charge": 172.0, "discounted_cash": 129.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 240.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.15, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.06, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CARDIOLIPIN ANTIBODY EACH IG CLASS 86147", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 103.2, "maximum": 240.8, "gross_charge": 172.0, "discounted_cash": 129.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 240.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.15, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.06, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 172.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "C1 ESTERASE INHIBITOR 86160", "code_information": [ { "code": "86160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.0, "maximum": 119.0, "gross_charge": 85.0, "discounted_cash": 63.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "COMPLEMENT TOTAL 50 86162", "code_information": [ { "code": "86162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.0, "maximum": 119.0, "gross_charge": 85.0, "discounted_cash": 63.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CONNECT TISS CYCLIC CITRULLINATED PEPTIDE AB 86200.003", "code_information": [ { "code": "86200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 81.0, "maximum": 189.0, "gross_charge": 135.0, "discounted_cash": 101.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.66, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 101.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SJORGRENS SYNDROME ANTIBODY 86235", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 76.2, "maximum": 177.8, "gross_charge": 127.0, "discounted_cash": 95.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 177.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 95.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY 86255", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.0, "maximum": 119.0, "gross_charge": 85.0, "discounted_cash": 63.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "1 ANCA TITER 86256", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.0, "maximum": 119.0, "gross_charge": 85.0, "discounted_cash": 63.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CA 125 86304", "code_information": [ { "code": "86304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 87.6, "maximum": 204.4, "gross_charge": 146.0, "discounted_cash": 109.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 204.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.54, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 109.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.25, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CHROMOGRANIN A 86316", "code_information": [ { "code": "86316", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 82.8, "maximum": 193.2, "gross_charge": 138.0, "discounted_cash": 103.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 193.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.81, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 103.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.16, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IMMUNOFIX ELECT24HR URINE86335", "code_information": [ { "code": "86335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 123.6, "maximum": 288.4, "gross_charge": 206.0, "discounted_cash": 154.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 206.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 206.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 288.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 206.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 206.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 206.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.5, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 206.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 206.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 154.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.97, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 206.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DIABETES MELLITUS TYPE 1 EVAL SERUM 86337.900", "code_information": [ { "code": "86337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 90.6, "maximum": 211.4, "gross_charge": 151.0, "discounted_cash": 113.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 211.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 113.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.06, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GLUTAMIC ACID DECARBOXYLASE AB SERUM 86341.907", "code_information": [ { "code": "86341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 76.2, "maximum": 177.8, "gross_charge": 127.0, "discounted_cash": 95.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 177.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 95.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ASPERGILLUS FUMIGATUS IGG AB SERUM 86606.901", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 61.2, "maximum": 142.8, "gross_charge": 102.0, "discounted_cash": 76.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 142.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.03, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 76.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BARTONELLA IGG/IGM SO 86611.005", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 54.0, "maximum": 126.0, "gross_charge": 90.0, "discounted_cash": 67.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.44, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 67.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LYMES DISEASE WESTERN BLOT 86617.900", "code_information": [ { "code": "86617", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 66.0, "maximum": 154.0, "gross_charge": 110.0, "discounted_cash": 82.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.76, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 82.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LYMES TOTAL 86618", "code_information": [ { "code": "86618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 72.0, "maximum": 168.0, "gross_charge": 120.0, "discounted_cash": 90.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 120.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 120.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 168.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 120.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 120.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 120.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.92, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 120.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 120.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 90.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.44, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 120.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CANDIDA ALBICANS AB 86628", "code_information": [ { "code": "86628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 49.2, "maximum": 114.8, "gross_charge": 82.0, "discounted_cash": 61.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 114.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.71, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 61.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CHLAMYDIA SPECIES AB IGG IGA 86631.902", "code_information": [ { "code": "86631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 48.6, "maximum": 113.4, "gross_charge": 81.0, "discounted_cash": 60.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 113.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.0, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 60.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CHLAMYDIA TRACHOMATIS AB IGG IGA 86631.901", "code_information": [ { "code": "86631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 48.6, "maximum": 113.4, "gross_charge": 81.0, "discounted_cash": 60.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 113.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.0, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 60.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CHLAMYDIA SPECIES AB IGM 86632.902", "code_information": [ { "code": "86632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.6, "maximum": 120.4, "gross_charge": 86.0, "discounted_cash": 64.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 120.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.58, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 64.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CHLAMYDIA TRACHOMATIS AB IGM 86632.901", "code_information": [ { "code": "86632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.6, "maximum": 120.4, "gross_charge": 86.0, "discounted_cash": 64.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 120.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.58, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 64.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "COCCIDIOIDES ANTIBODY 86635", "code_information": [ { "code": "86635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 48.6, "maximum": 113.4, "gross_charge": 81.0, "discounted_cash": 60.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 113.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.0, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 60.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "COCCI IMMUNODIFF IGG", "code_information": [ { "code": "86635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 16.8, "maximum": 39.2, "gross_charge": 28.0, "discounted_cash": 21.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 39.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.05, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "COCCI IMMUNODIFF IGM", "code_information": [ { "code": "86635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 16.8, "maximum": 39.2, "gross_charge": 28.0, "discounted_cash": 21.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 39.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.05, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "COCCI COMPLEMENT F", "code_information": [ { "code": "86635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 16.8, "maximum": 39.2, "gross_charge": 28.0, "discounted_cash": 21.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 39.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.05, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "Q FEVER AB SCREEN W TITER RELFEX S 86638.900", "code_information": [ { "code": "86638", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 49.2, "maximum": 114.8, "gross_charge": 82.0, "discounted_cash": 61.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 114.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.71, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 61.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CMV IGG AB 86644", "code_information": [ { "code": "86644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 57.0, "maximum": 133.0, "gross_charge": 95.0, "discounted_cash": 71.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.02, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 71.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.39, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CMV IGM AB 86645", "code_information": [ { "code": "86645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 55.8, "maximum": 130.2, "gross_charge": 93.0, "discounted_cash": 69.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 130.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.59, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 69.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "EBNA", "code_information": [ { "code": "86664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 16.8, "maximum": 39.2, "gross_charge": 28.0, "discounted_cash": 21.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 39.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.05, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "EBV IGG", "code_information": [ { "code": "86665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 11.4, "maximum": 26.6, "gross_charge": 19.0, "discounted_cash": 14.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 14.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "EBV IGM", "code_information": [ { "code": "86665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 11.4, "maximum": 26.6, "gross_charge": 19.0, "discounted_cash": 14.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 14.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 19.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "EHRLICHIA CHAF IGG M AB 86666", "code_information": [ { "code": "86666", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 43.2, "maximum": 100.8, "gross_charge": 72.0, "discounted_cash": 54.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 100.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.55, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 54.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.86, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "FRANCISELLA AB SERUM 86668", "code_information": [ { "code": "86668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 56.4, "maximum": 131.6, "gross_charge": 94.0, "discounted_cash": 70.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 131.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.3, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 70.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 94.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE PNL AB FUNGUS NES 86671.901", "code_information": [ { "code": "86671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 49.8, "maximum": 116.2, "gross_charge": 83.0, "discounted_cash": 62.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 116.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.43, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 62.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.25, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HISTOPLASMA AB 86698", "code_information": [ { "code": "86698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 55.2, "maximum": 128.8, "gross_charge": 92.0, "discounted_cash": 69.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 128.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.87, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 69.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 92.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HEP B CORE AB-IGM ONLY 86705", "code_information": [ { "code": "86705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 49.8, "maximum": 116.2, "gross_charge": 83.0, "discounted_cash": 62.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 116.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.43, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 62.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.25, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HEPATITIS BE ANTIBODY 86707.900", "code_information": [ { "code": "86707", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 49.2, "maximum": 114.8, "gross_charge": 82.0, "discounted_cash": 61.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 114.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.71, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 61.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HEPATITIS A ANTIBODY HAAB 86708", "code_information": [ { "code": "86708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 52.2, "maximum": 121.8, "gross_charge": 87.0, "discounted_cash": 65.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 121.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.29, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 65.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.29, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HEPATITIS A ANTIBODY (HAAB) IGM ANTIBODY 86709", "code_information": [ { "code": "86709", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 45.0, "maximum": 105.0, "gross_charge": 75.0, "discounted_cash": 56.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.7, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 56.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MYCOPLASMA ANTIBODY TITER86738", "code_information": [ { "code": "86738", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 55.8, "maximum": 130.2, "gross_charge": 93.0, "discounted_cash": 69.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 130.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.59, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 69.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PARVOVIRUS IGM IGG 86747", "code_information": [ { "code": "86747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 63.6, "maximum": 148.4, "gross_charge": 106.0, "discounted_cash": 79.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 148.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 79.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CDMR SARS-COV-2 COVID-19 ANTIBODY 86769", "code_information": [ { "code": "86769", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 87.6, "maximum": 204.4, "gross_charge": 146.0, "discounted_cash": 109.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 204.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.54, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 109.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.25, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTIBODY TOXOPLASMA 86777", "code_information": [ { "code": "86777", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 63.6, "maximum": 148.4, "gross_charge": 106.0, "discounted_cash": 79.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 148.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 79.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 106.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTIBODY TOXOPLASMA IGM 86778", "code_information": [ { "code": "86778", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.0, "maximum": 140.0, "gross_charge": 100.0, "discounted_cash": 75.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTI THYROGLOBULIN AB 86800", "code_information": [ { "code": "86800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 67.2, "maximum": 156.8, "gross_charge": 112.0, "discounted_cash": 84.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 156.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.19, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 112.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANTIBODY ID 86870", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 343.8, "maximum": 802.2, "gross_charge": 573.0, "discounted_cash": 429.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 343.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 573.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 573.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 802.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 515.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 515.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 515.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 573.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 458.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 573.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 515.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 573.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 410.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 573.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 687.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 573.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 458.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 429.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 573.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DIRECT COOMBS 86880", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23.4, "maximum": 54.6, "gross_charge": 39.0, "discounted_cash": 29.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 54.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 29.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RBC ANTIGEN TYPING PT 86905", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 16.8, "maximum": 39.2, "gross_charge": 28.0, "discounted_cash": 21.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 39.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.05, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CROSSMATCH IMMEDIATESPIN 86920", "code_information": [ { "code": "86920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 155.4, "maximum": 362.6, "gross_charge": 259.0, "discounted_cash": 194.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 259.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 259.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 362.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 259.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 259.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 259.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.44, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 259.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 310.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 259.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 194.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.36, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 259.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CROSSMATCH ANTIGLOBULIN 86922", "code_information": [ { "code": "86922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 155.4, "maximum": 362.6, "gross_charge": 259.0, "discounted_cash": 194.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 259.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 259.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 362.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 259.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 259.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 259.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.44, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 259.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 310.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 259.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 194.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.36, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 259.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CONCENTRATE INFECT AGENT 87015", "code_information": [ { "code": "87015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 26.4, "maximum": 61.6, "gross_charge": 44.0, "discounted_cash": 33.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 44.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 61.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 44.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 44.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 44.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.5, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 44.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 44.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 33.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 44.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ANAEROBIC IDENTIFICATION 87076", "code_information": [ { "code": "87076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 34.8, "maximum": 81.2, "gross_charge": 58.0, "discounted_cash": 43.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 81.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.53, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 43.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ISOLAT&PRESUMPT ID URINE 87088", "code_information": [ { "code": "87088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 34.8, "maximum": 81.2, "gross_charge": 58.0, "discounted_cash": 43.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 81.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.53, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 43.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 58.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CULTURE:FC SKN-HAIR-NAIL 87101", "code_information": [ { "code": "87101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 33.0, "maximum": 77.0, "gross_charge": 55.0, "discounted_cash": 41.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 55.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 55.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 55.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 55.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 55.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.38, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 55.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 55.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 41.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.91, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 55.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CULTURE: FUNGUS", "code_information": [ { "code": "87102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 36.0, "maximum": 84.0, "gross_charge": 60.0, "discounted_cash": 45.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 60.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 60.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 60.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 60.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.96, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 60.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 60.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 45.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 60.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CULTURE: FUNGUS BLOOD 87103", "code_information": [ { "code": "87103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 81.6, "maximum": 190.4, "gross_charge": 136.0, "discounted_cash": 102.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 190.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.38, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CULTURE: FUNGUS YEAST ID", "code_information": [ { "code": "87106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 43.2, "maximum": 100.8, "gross_charge": 72.0, "discounted_cash": 54.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 100.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.55, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 54.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.86, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CULTURE TYPING ID BY NUCLEIC ACID PROBE 87149", "code_information": [ { "code": "87149", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 50.4, "maximum": 117.6, "gross_charge": 84.0, "discounted_cash": 63.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.01, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 84.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CULTURE TYPE ID DNA RNA PROBE 87150", "code_information": [ { "code": "87150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 147.6, "maximum": 344.4, "gross_charge": 246.0, "discounted_cash": 184.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 344.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 184.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PIN WORM EXAM 87172", "code_information": [ { "code": "87172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 18.6, "maximum": 43.4, "gross_charge": 31.0, "discounted_cash": 23.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 43.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 23.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.62, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SENSITIVITY AEROB MIC 87186.900", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 16.8, "maximum": 39.2, "gross_charge": 28.0, "discounted_cash": 21.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 39.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.05, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 21.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 28.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "WET MOUNT INFECT AGENT 87210", "code_information": [ { "code": "87210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23.4, "maximum": 54.6, "gross_charge": 39.0, "discounted_cash": 29.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 54.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 29.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 39.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "KOH SKIN HAIR NAILS 87220", "code_information": [ { "code": "87220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 18.6, "maximum": 43.4, "gross_charge": 31.0, "discounted_cash": 23.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 43.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 23.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.62, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 31.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CULTURE VIRAL 87252", "code_information": [ { "code": "87252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 110.4, "maximum": 257.6, "gross_charge": 184.0, "discounted_cash": 138.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 184.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 257.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 184.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 184.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 184.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.74, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 184.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 184.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.21, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 184.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CLOSTRIDIUM DIFFICILE A/B TOXIN DETECTION 87324", "code_information": [ { "code": "87324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.0, "maximum": 119.0, "gross_charge": 85.0, "discounted_cash": 63.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HEPATITIS BE ANTIGEN 87350.900", "code_information": [ { "code": "87350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 49.2, "maximum": 114.8, "gross_charge": 82.0, "discounted_cash": 61.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 114.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.71, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 61.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 82.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "INF AGNT ANTG DETECT BY IA ROTAVIRUS 87425", "code_information": [ { "code": "87425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.0, "maximum": 119.0, "gross_charge": 85.0, "discounted_cash": 63.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CDMR CORONAVIRUS AG IA 87426", "code_information": [ { "code": "87426", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 73.8, "maximum": 172.2, "gross_charge": 123.0, "discounted_cash": 92.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 172.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.07, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 92.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.73, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "INF AGNT ANTGN DETECT BY IA NOS EA ORGANISM 87449.009", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 160.8, "maximum": 375.2, "gross_charge": 268.0, "discounted_cash": 201.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 268.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 268.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 268.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 268.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 268.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.89, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 268.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 268.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 201.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.22, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 268.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "FUNGITELL BETA-D-GLUCAN, NON-BLOOD 87449.900", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 160.8, "maximum": 375.2, "gross_charge": 268.0, "discounted_cash": 201.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 268.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 268.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 268.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 268.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 268.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.89, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 268.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 268.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 201.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.22, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 268.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CHLAMYDIA TRACH OTHER THAN OCULAR PERITONEAL 87491.902", "code_information": [ { "code": "87491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 147.6, "maximum": 344.4, "gross_charge": 246.0, "discounted_cash": 184.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 344.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 184.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CYTOMEGALOVIRUS (CMV) DETECT BY PRC QUAL NON-BLD 87496", "code_information": [ { "code": "87496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 142.2, "maximum": 331.8, "gross_charge": 237.0, "discounted_cash": 177.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 237.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 237.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 331.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 237.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 237.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 237.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.69, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 237.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 237.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 177.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.59, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 237.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CMV DNA DETECT AND QUANT 87497.900", "code_information": [ { "code": "87497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 173.4, "maximum": 404.6, "gross_charge": 289.0, "discounted_cash": 216.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 289.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 289.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 404.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 289.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 289.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 289.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.92, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 289.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 346.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 289.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 216.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.22, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 289.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "NUCLEIC ACID VANCOMYCIN RESIST 87500", "code_information": [ { "code": "87500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 147.6, "maximum": 344.4, "gross_charge": 246.0, "discounted_cash": 184.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 344.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 184.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CDMR INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES 87502", "code_information": [ { "code": "87502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 379.8, "maximum": 886.2, "gross_charge": 633.0, "discounted_cash": 474.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 379.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 633.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 633.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 886.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 569.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 569.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 569.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 633.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 506.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 633.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 569.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 633.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 453.23, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 633.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 759.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 633.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 506.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 474.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 482.35, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 633.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BASIC ENTERIC PATHOGENIC PANEL NAD 87506", "code_information": [ { "code": "87506", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1041.0, "maximum": 2429.0, "gross_charge": 1735.0, "discounted_cash": 1301.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1041.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1735.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1735.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2429.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1561.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1561.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1561.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1735.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1388.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1735.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1561.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1735.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1242.26, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1735.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2082.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1735.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1388.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1301.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1322.07, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1735.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HERPES SIMPLEX VIRUS 87529.900", "code_information": [ { "code": "87529", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 147.6, "maximum": 344.4, "gross_charge": 246.0, "discounted_cash": 184.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 344.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 184.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HIV 1 RNA PCR QNT 87536", "code_information": [ { "code": "87536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 337.2, "maximum": 786.8, "gross_charge": 562.0, "discounted_cash": 421.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 562.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 562.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 786.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 562.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 449.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 562.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 562.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.39, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 562.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 674.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 562.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 449.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 421.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.24, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 562.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "NEISSERIA GONORRHEA OTHER THAN OCULAR PERITONEAL 87591.902", "code_information": [ { "code": "87591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 147.6, "maximum": 344.4, "gross_charge": 246.0, "discounted_cash": 184.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 344.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 184.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "INFECT AGNT DNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES 87624", "code_information": [ { "code": "87624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 147.0, "maximum": 343.0, "gross_charge": 245.0, "discounted_cash": 183.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 343.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.42, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 294.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 183.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.69, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IADNA HPV SEP RPRT HI RSK TYP AND HI RSK POOLD RSLTS 87626", "code_information": [ { "code": "87626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 109.8, "maximum": 256.2, "gross_charge": 183.0, "discounted_cash": 137.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 183.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 183.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 256.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 183.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 183.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 183.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.03, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 183.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 219.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 183.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 137.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 183.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CDMR SARSCOV2 & INF A&B AMP PRB 87636", "code_information": [ { "code": "87636", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 178.2, "maximum": 415.8, "gross_charge": 297.0, "discounted_cash": 222.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 415.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.65, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 222.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.31, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CDMR SARSCOV2&INF A&B&RSV AMP PRB 87637", "code_information": [ { "code": "87637", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 178.2, "maximum": 415.8, "gross_charge": 297.0, "discounted_cash": 222.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 415.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.65, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 222.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.31, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TRICHOMONAS VAGINALIS BY NUCLEIC ACID DETECTION 87661", "code_information": [ { "code": "87661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 142.2, "maximum": 331.8, "gross_charge": 237.0, "discounted_cash": 177.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 237.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 237.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 331.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 237.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 237.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 237.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.69, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 237.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 237.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 177.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.59, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 237.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "VARICELLA ZOSTR PCR CSF", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 147.6, "maximum": 344.4, "gross_charge": 246.0, "discounted_cash": 184.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 344.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 184.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "EPSTEIN BARR PCR NON-BLOOD 87798", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 147.6, "maximum": 344.4, "gross_charge": 246.0, "discounted_cash": 184.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 344.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 184.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PERTUSSIS PCR 87798", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 147.6, "maximum": 344.4, "gross_charge": 246.0, "discounted_cash": 184.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 344.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 184.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PARVOVIRUS B19 QUAL PCR 87798", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 147.6, "maximum": 344.4, "gross_charge": 246.0, "discounted_cash": 184.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 344.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 184.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BABESIA PCR 87798", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 147.6, "maximum": 344.4, "gross_charge": 246.0, "discounted_cash": 184.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 344.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 184.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 246.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "NOROVIRUS BY NAD 87798", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 195.6, "maximum": 456.4, "gross_charge": 326.0, "discounted_cash": 244.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 326.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 326.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 456.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 293.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 293.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 293.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 326.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 326.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 293.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 326.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.42, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 326.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 326.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 244.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 248.41, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 326.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RSV DIRECT ELISA 87807", "code_information": [ { "code": "87807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 52.2, "maximum": 121.8, "gross_charge": 87.0, "discounted_cash": 65.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 121.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.29, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 65.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.29, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 87.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RPD GROUP A STREP SCREEN 87880", "code_information": [ { "code": "87880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 66.0, "maximum": 154.0, "gross_charge": 110.0, "discounted_cash": 82.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.76, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 82.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 110.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "S PNEUMONONIAE DIRECT ANTIGEN URINE 87899.009", "code_information": [ { "code": "87899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 64.2, "maximum": 149.8, "gross_charge": 107.0, "discounted_cash": 80.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 149.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.61, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 80.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "LEGIONELLA ANTIGEN URINE 87899.010", "code_information": [ { "code": "87899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 64.2, "maximum": 149.8, "gross_charge": 107.0, "discounted_cash": 80.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 149.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.61, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 80.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HEPATITIS C VIRUS GENOTYPE 87902.900", "code_information": [ { "code": "87902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1081.8, "maximum": 2524.2, "gross_charge": 1803.0, "discounted_cash": 1352.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1081.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1803.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1803.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2524.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1622.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1622.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1622.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1803.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1442.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1803.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1622.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1803.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1290.95, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1803.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2163.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1803.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1442.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1352.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1373.89, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1803.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CYTOPATH WINTERP 88112", "code_information": [ { "code": "88112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 91.2, "maximum": 212.8, "gross_charge": 152.0, "discounted_cash": 114.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 212.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.83, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CYTO CERV THN MAN 88142", "code_information": [ { "code": "88142", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 85.8, "maximum": 200.2, "gross_charge": 143.0, "discounted_cash": 107.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 200.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.39, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 107.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.97, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CYTO CERV THN AUTO 88175", "code_information": [ { "code": "88175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 111.6, "maximum": 260.4, "gross_charge": 186.0, "discounted_cash": 139.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 186.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 186.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 260.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 186.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 186.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 186.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.18, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 186.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 186.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 139.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.73, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 186.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SURGICAL PATH LEVEL III 88304", "code_information": [ { "code": "88304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 100.2, "maximum": 233.8, "gross_charge": 167.0, "discounted_cash": 125.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 167.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 167.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 233.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 167.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 167.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 167.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.57, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 167.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 167.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 125.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.25, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 167.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SYNOVIAL CELL COUNT 89050", "code_information": [ { "code": "89050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 20.4, "maximum": 47.6, "gross_charge": 34.0, "discounted_cash": 25.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 47.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 25.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.91, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BODY FLUID CELL COUNT 89050", "code_information": [ { "code": "89050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 20.4, "maximum": 47.6, "gross_charge": 34.0, "discounted_cash": 25.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 47.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 25.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.91, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 34.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HNDOT(HANDLING OTHER KITS) 99000", "code_information": [ { "code": "99000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 13.8, "maximum": 32.2, "gross_charge": 23.0, "discounted_cash": 17.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 32.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.47, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 17.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 23.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ONC PAN TUM WHL GEN SEQ PAIRED MAL&NML DNA SPEC 0297U", "code_information": [ { "code": "310", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 48.6, "maximum": 113.4, "gross_charge": 81.0, "discounted_cash": 60.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 113.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.0, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 60.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DRUG TEST DEFINITIVE 1-7 CLASSES G0480", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 453.6, "maximum": 1058.4, "gross_charge": 756.0, "discounted_cash": 567.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 453.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1058.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 680.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 680.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 680.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 604.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 680.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 541.3, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 907.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 604.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 567.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 576.07, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SCREEN PAP BY TECH P3000", "code_information": [ { "code": "P3000", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.0, "maximum": 140.0, "gross_charge": 100.0, "discounted_cash": 75.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 75.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 100.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PLATELET PHERESIS LEUKOREDUCED EA UNIT P9035", "code_information": [ { "code": "P9035", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 628.8, "maximum": 1467.2, "gross_charge": 1048.0, "discounted_cash": 786.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 628.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1467.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 943.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 943.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 943.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 838.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 943.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 750.37, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1257.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 838.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 786.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 798.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BLOOD ALCOHOL OR DRUG DRAW", "code_information": [ { "code": "990", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 37.2, "maximum": 86.8, "gross_charge": 62.0, "discounted_cash": 46.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 86.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.39, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 46.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.24, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 62.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT ABD PELVIS W CONTRAST", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1731.21, "maximum": 4039.49, "gross_charge": 2885.35, "discounted_cash": 2164.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1731.21, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2885.35, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2885.35, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4039.49, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596.82, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596.82, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596.82, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2885.35, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2308.28, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2885.35, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596.82, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2885.35, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2065.91, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2885.35, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3462.42, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2885.35, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2308.28, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2164.01, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2198.64, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2885.35, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT HEAD WO CONTRAST", "code_information": [ { "code": "70450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 635.49, "maximum": 1482.81, "gross_charge": 1059.1499999999999, "discounted_cash": 794.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 635.49, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1059.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1059.1499999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1482.81, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 953.23, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 953.23, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 953.23, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1059.1499999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 847.32, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1059.1499999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 953.23, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1059.1499999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 758.35, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1059.1499999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1270.98, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1059.1499999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 847.32, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 794.36, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 807.07, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1059.1499999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT ABD PELVIS WO CONTRAST", "code_information": [ { "code": "74176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 796.95, "maximum": 1859.55, "gross_charge": 1328.25, "discounted_cash": 996.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 796.95, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1328.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1328.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1859.55, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1195.42, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1195.42, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1195.42, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1328.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1062.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1328.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1195.42, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1328.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 951.03, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1328.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1593.9, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1328.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1062.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 996.19, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1012.13, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1328.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT THORAX DIAGNOSTIC WO CONTRAST", "code_information": [ { "code": "71250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 815.58, "maximum": 1903.02, "gross_charge": 1359.3, "discounted_cash": 1019.47, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 815.58, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1359.3, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1359.3, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1903.02, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1223.37, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1223.37, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1223.37, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1359.3, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1087.44, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1359.3, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1223.37, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1359.3, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 973.26, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1359.3, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1631.16, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1359.3, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1087.44, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1019.47, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1035.79, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1359.3, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CTA CHEST WCONT +WO IF PERF", "code_information": [ { "code": "71275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1520.07, "maximum": 3546.83, "gross_charge": 2533.45, "discounted_cash": 1900.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1520.07, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2533.45, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2533.45, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3546.83, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2280.11, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2280.11, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2280.11, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2533.45, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2026.76, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2533.45, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2280.11, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2533.45, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1813.95, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2533.45, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3040.14, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2533.45, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2026.76, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1900.09, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1930.49, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2533.45, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT CERVICAL SPINE WO CONTRAST", "code_information": [ { "code": "72125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 894.93, "maximum": 2088.17, "gross_charge": 1491.55, "discounted_cash": 1118.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 894.93, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1491.55, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1491.55, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2088.17, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1342.39, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1342.39, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1342.39, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1491.55, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1193.24, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1491.55, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1342.39, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1491.55, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1067.95, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1491.55, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1789.86, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1491.55, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1193.24, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1118.66, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1136.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1491.55, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT ABD PELVIS WO THEN W CONT", "code_information": [ { "code": "74178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1956.84, "maximum": 4565.96, "gross_charge": 3261.3999999999996, "discounted_cash": 2446.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1956.84, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3261.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3261.3999999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4565.96, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2935.26, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2935.26, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2935.26, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3261.3999999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2609.12, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3261.3999999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2935.26, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3261.3999999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2335.16, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3261.3999999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3913.68, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3261.3999999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2609.12, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2446.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2485.19, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3261.3999999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI UPPER EXT JT WO CONTRAST", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1476.6, "maximum": 3445.4, "gross_charge": 2461.0, "discounted_cash": 1845.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1476.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2461.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2461.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3445.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2214.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2214.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2214.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2461.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1968.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2461.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2214.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2461.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1762.08, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2461.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2953.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2461.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1968.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1845.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1875.28, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2461.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT THORAX DIAGNOSTIC WITH CONTRAST", "code_information": [ { "code": "71260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1053.63, "maximum": 2458.47, "gross_charge": 1756.05, "discounted_cash": 1317.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1053.63, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1756.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1756.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1580.44, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1580.44, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1580.44, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1756.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1404.84, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1756.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1580.44, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1756.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1257.33, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1756.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2107.26, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1756.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1404.84, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1317.04, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1338.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1756.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CTA HEAD W CONT WO IF PERF", "code_information": [ { "code": "70496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1604.94, "maximum": 3744.86, "gross_charge": 2674.8999999999996, "discounted_cash": 2006.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1604.94, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2674.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2674.8999999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3744.86, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2407.41, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2407.41, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2407.41, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2674.8999999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2139.92, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2674.8999999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2407.41, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2674.8999999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1915.23, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2674.8999999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3209.88, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2674.8999999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2139.92, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2006.17, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2038.27, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2674.8999999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI L SPINE WO CONTRAST", "code_information": [ { "code": "72148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1460.73, "maximum": 3408.37, "gross_charge": 2434.5499999999997, "discounted_cash": 1825.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1460.73, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2434.55, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2434.5499999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3408.37, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2191.09, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2191.09, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2191.09, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2434.5499999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1947.64, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2434.5499999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2191.09, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2434.5499999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1743.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2434.5499999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2921.46, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2434.5499999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1947.64, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1825.91, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1855.13, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2434.5499999999997, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT ANGIO NECK W CON+WO IF PERF", "code_information": [ { "code": "70498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1607.7, "maximum": 3751.3, "gross_charge": 2679.5, "discounted_cash": 2009.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1607.7, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2679.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2679.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3751.3, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2411.55, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2411.55, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2411.55, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2679.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2143.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2679.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2411.55, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2679.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1918.52, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2679.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3215.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2679.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2143.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2009.62, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2041.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2679.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ECHO (2D) COMPLETE W DOPPLER & COLOR", "code_information": [ { "code": "93306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 497.49, "maximum": 1160.81, "gross_charge": 829.15, "discounted_cash": 621.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 497.49, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 829.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 829.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 746.24, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 746.24, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 746.24, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 829.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 663.32, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 829.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 746.24, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 829.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 593.67, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 829.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 994.98, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 829.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 663.32, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 621.86, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 631.81, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 829.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI C SPINE WO CONTRAST", "code_information": [ { "code": "72141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1368.96, "maximum": 3194.24, "gross_charge": 2281.6, "discounted_cash": 1711.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1368.96, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2281.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2281.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3194.24, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2053.44, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2053.44, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2053.44, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2281.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1825.28, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2281.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2053.44, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2281.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1633.63, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2281.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2737.92, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2281.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1825.28, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1711.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1738.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2281.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM CHEST 2 VWS", "code_information": [ { "code": "71046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 86.94, "maximum": 202.86, "gross_charge": 144.89999999999998, "discounted_cash": 108.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.94, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 144.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 144.89999999999998, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 202.86, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.41, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.41, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.41, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 144.89999999999998, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.92, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 144.89999999999998, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.41, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 144.89999999999998, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.75, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 144.89999999999998, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.88, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 144.89999999999998, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.92, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 108.67, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.41, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 144.89999999999998, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM CHEST SINGLE VW", "code_information": [ { "code": "71045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 62.79, "maximum": 146.51, "gross_charge": 104.64999999999999, "discounted_cash": 78.49, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.79, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 104.65, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 104.64999999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 146.51, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.18, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.18, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.18, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 104.64999999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.72, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 104.64999999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.18, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 104.64999999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 104.64999999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.58, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 104.64999999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.72, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 78.49, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.74, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 104.64999999999999, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI BRAIN WO THEN W CONT", "code_information": [ { "code": "70553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2305.29, "maximum": 5379.01, "gross_charge": 3842.1499999999996, "discounted_cash": 2881.61, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2305.29, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3842.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3842.1499999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 5379.01, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3457.93, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3457.93, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 3457.93, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3842.1499999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3073.72, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3842.1499999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3457.93, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3842.1499999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2750.98, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3842.1499999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 4610.58, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3842.1499999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3073.72, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2881.61, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2927.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3842.1499999999996, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI LOWER EXT JT WO CONTRAST", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1513.86, "maximum": 3532.34, "gross_charge": 2523.1, "discounted_cash": 1892.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1513.86, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2523.1, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2523.1, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3532.34, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2270.79, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2270.79, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2270.79, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2523.1, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2018.48, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2523.1, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2270.79, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2523.1, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1806.54, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2523.1, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3027.72, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2523.1, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2018.48, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1892.32, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1922.6, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2523.1, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT LUMBAR SPINE WO CONT", "code_information": [ { "code": "72131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 888.03, "maximum": 2072.07, "gross_charge": 1480.05, "discounted_cash": 1110.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 888.03, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1480.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1480.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2072.07, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1332.05, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1332.05, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1332.05, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1480.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1184.04, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1480.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1332.05, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1480.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1059.72, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1480.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1776.06, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1480.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1184.04, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1110.04, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1127.8, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1480.05, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT MAXILLOFACIAL WO CONT", "code_information": [ { "code": "70486", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 721.05, "maximum": 1682.45, "gross_charge": 1201.75, "discounted_cash": 901.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 721.05, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1201.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1201.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1682.45, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1081.58, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1081.58, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1081.58, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1201.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 961.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1201.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1081.58, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1201.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 860.45, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1201.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1442.1, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1201.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 961.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 901.31, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 915.73, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1201.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT EXT LOWER WO CONT", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 772.2, "maximum": 1801.8, "gross_charge": 1287.0, "discounted_cash": 965.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 772.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1801.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1158.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1158.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1158.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1029.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1158.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 921.49, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1544.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1029.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 965.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 980.69, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1287.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT PELVIS WO CONTRAST", "code_information": [ { "code": "72192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 685.8, "maximum": 1600.2, "gross_charge": 1143.0, "discounted_cash": 857.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 685.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1600.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1028.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1028.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1028.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 914.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1028.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 818.39, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1371.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 914.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 857.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 870.97, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT HEAD WO THEN W CONTRAST", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 840.0, "maximum": 1960.0, "gross_charge": 1400.0, "discounted_cash": 1050.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1400.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1400.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1960.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1260.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1260.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1260.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1400.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1120.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1400.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1260.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1400.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1002.4, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1400.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1680.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1400.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1120.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1050.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1066.8, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1400.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CTA ABD PELVIS W CONTRAST+WO IF PERFORM", "code_information": [ { "code": "74174", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1877.4, "maximum": 4380.6, "gross_charge": 3129.0, "discounted_cash": 2346.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1877.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4380.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2816.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2816.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2816.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2503.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2816.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2240.36, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3754.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2503.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2346.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.3, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT SOFT TISSUE NECK W CONTRAST", "code_information": [ { "code": "70491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 910.2, "maximum": 2123.8, "gross_charge": 1517.0, "discounted_cash": 1137.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 910.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1517.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1517.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2123.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1365.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1365.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1365.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1517.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1213.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1517.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1365.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1517.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1086.17, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1517.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1820.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1517.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1213.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1137.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1155.95, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1517.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US SOFT TISSUE HEAD NECK", "code_information": [ { "code": "76536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 289.8, "maximum": 676.2, "gross_charge": 483.0, "discounted_cash": 362.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 289.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 483.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 483.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 676.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 483.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 483.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 483.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 345.83, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 483.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 579.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 483.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 362.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.05, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 483.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CTA ABD AO & EXT W CONTRAST+WO IF PERFORM", "code_information": [ { "code": "75635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2029.2, "maximum": 4734.8, "gross_charge": 3382.0, "discounted_cash": 2536.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2029.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3382.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3382.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4734.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3043.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3043.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 3043.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3382.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2705.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3382.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3043.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3382.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2421.51, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3382.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 4058.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3382.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2705.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2536.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2577.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3382.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI C SPINE WO THEN W CONT", "code_information": [ { "code": "72156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1969.2, "maximum": 4594.8, "gross_charge": 3282.0, "discounted_cash": 2461.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1969.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3282.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3282.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4594.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2953.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2953.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2953.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3282.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2625.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3282.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2953.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3282.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2349.91, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3282.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3938.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3282.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2625.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2461.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2500.88, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3282.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI BRAIN WO CONTRAST", "code_information": [ { "code": "70551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 895.2, "maximum": 2088.8, "gross_charge": 1492.0, "discounted_cash": 1119.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 895.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1492.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1492.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2088.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1342.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1342.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1342.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1492.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1193.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1492.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1342.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1492.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1068.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1492.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1790.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1492.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1193.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1136.9, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1492.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM HIP UNILAT W PELV WHEN PERF 2 OR 3 VWS", "code_information": [ { "code": "73502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 115.8, "maximum": 270.2, "gross_charge": 193.0, "discounted_cash": 144.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 193.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 193.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 270.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 193.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 193.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 193.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.19, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 193.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 193.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 144.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.07, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 193.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI LOWER EXT WO CONTRAST", "code_information": [ { "code": "73718", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1630.8, "maximum": 3805.2, "gross_charge": 2718.0, "discounted_cash": 2038.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1630.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2718.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2718.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3805.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2446.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2446.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2446.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2718.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2174.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2718.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2446.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2718.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1946.09, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2718.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3261.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2718.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2174.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2038.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2071.12, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2718.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM KNEE 3 VWS", "code_information": [ { "code": "73562", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 101.4, "maximum": 236.6, "gross_charge": 169.0, "discounted_cash": 126.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 236.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.0, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 126.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SHOULDER COMPL MIN 2 VWS", "code_information": [ { "code": "73030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 81.6, "maximum": 190.4, "gross_charge": 136.0, "discounted_cash": 102.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 190.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.38, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM ANKLE MIN 3 VWS", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 91.2, "maximum": 212.8, "gross_charge": 152.0, "discounted_cash": 114.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 212.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.83, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM FOOT MIN 3 VWS", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 85.2, "maximum": 198.8, "gross_charge": 142.0, "discounted_cash": 106.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 198.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.67, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 106.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT THORAX LW DOSE LUNG CA SCR NO CONTRAST", "code_information": [ { "code": "71271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 589.8, "maximum": 1376.2, "gross_charge": 983.0, "discounted_cash": 737.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 589.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 983.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 983.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1376.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 884.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 884.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 884.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 983.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 786.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 983.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 884.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 983.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 703.83, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 983.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1179.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 983.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 786.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 737.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 749.05, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 983.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT THORAX DIAGNOSTIC WO THEN W CONTRAST", "code_information": [ { "code": "71270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1128.6, "maximum": 2633.4, "gross_charge": 1881.0, "discounted_cash": 1410.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1128.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1881.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1881.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2633.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1692.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1692.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1692.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1881.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1881.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1692.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1881.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1346.8, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1881.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2257.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1881.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1410.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1433.32, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1881.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI LOWER EXT JT WO THEN W CONT", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2106.6, "maximum": 4915.4, "gross_charge": 3511.0, "discounted_cash": 2633.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2106.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3511.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3511.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4915.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3159.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3159.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 3159.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3511.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2808.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3511.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3159.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3511.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2513.88, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3511.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 4213.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3511.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2808.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2633.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2675.38, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3511.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM WRIST COMPL MIN 3 VWS", "code_information": [ { "code": "73110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 103.8, "maximum": 242.2, "gross_charge": 173.0, "discounted_cash": 129.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 173.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 173.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 242.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 173.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 173.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 173.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.87, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 173.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 173.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 129.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.83, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 173.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US ABD COMPLETE", "code_information": [ { "code": "76700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 295.8, "maximum": 690.2, "gross_charge": 493.0, "discounted_cash": 369.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 690.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.99, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 369.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI FACE NECK ORB WO THEN W CONT", "code_information": [ { "code": "70543", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2056.8, "maximum": 4799.2, "gross_charge": 3428.0, "discounted_cash": 2571.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2056.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3428.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3428.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4799.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3085.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3085.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 3085.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3428.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3428.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3085.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3428.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2454.45, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3428.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 4113.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3428.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2571.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2612.14, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3428.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT EXT UPPER W CONT", "code_information": [ { "code": "73201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1019.4, "maximum": 2378.6, "gross_charge": 1699.0, "discounted_cash": 1274.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1019.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1699.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1699.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2378.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1529.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1529.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1529.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1699.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1359.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1699.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1529.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1699.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1216.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1699.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2038.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1699.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1359.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1274.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1294.64, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1699.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT EXT LOWER W CONT", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 999.0, "maximum": 2331.0, "gross_charge": 1665.0, "discounted_cash": 1248.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 999.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1665.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1665.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2331.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1498.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1498.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1498.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1665.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1332.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1665.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1498.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1665.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1192.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1665.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1998.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1665.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1332.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1248.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1268.73, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1665.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM HAND MIN 3 VWS", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 90.6, "maximum": 211.4, "gross_charge": 151.0, "discounted_cash": 113.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 211.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 113.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.06, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 151.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI L SPINE WO THEN W CONT", "code_information": [ { "code": "72158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1966.2, "maximum": 4587.8, "gross_charge": 3277.0, "discounted_cash": 2457.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1966.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4587.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2949.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2949.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2949.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2621.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2949.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2346.33, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3932.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2621.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2457.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2497.07, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SPINE LUMB 2 OR 3 VWS", "code_information": [ { "code": "72100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 93.0, "maximum": 217.0, "gross_charge": 155.0, "discounted_cash": 116.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 155.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 155.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 155.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 155.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 155.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.98, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 155.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 155.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 116.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 155.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI T SPINE WO THEN W CONT", "code_information": [ { "code": "72157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1966.2, "maximum": 4587.8, "gross_charge": 3277.0, "discounted_cash": 2457.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1966.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4587.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2949.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2949.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2949.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2621.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2949.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2346.33, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3932.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2621.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2457.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2497.07, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRA HEAD WO CONTRAST", "code_information": [ { "code": "70544", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1821.6, "maximum": 4250.4, "gross_charge": 3036.0, "discounted_cash": 2277.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1821.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3036.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3036.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4250.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2732.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2732.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2732.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3036.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2428.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3036.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2732.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3036.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2173.78, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3036.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3643.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3036.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2428.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2313.43, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3036.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DUP CAROTID BILAT", "code_information": [ { "code": "93880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 571.2, "maximum": 1332.8, "gross_charge": 952.0, "discounted_cash": 714.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 571.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 952.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 952.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1332.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 856.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 856.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 856.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 952.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 761.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 952.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 856.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 952.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 681.63, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 952.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1142.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 952.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 761.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 714.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 725.42, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 952.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DUPLEX VENOUS EXT LTD UNILAT", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 420.6, "maximum": 981.4, "gross_charge": 701.0, "discounted_cash": 525.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 420.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 701.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 701.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 981.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 630.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 630.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 630.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 701.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 701.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 630.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 701.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.92, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 701.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 841.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 701.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 525.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 534.16, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 701.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT EXT UPPER WO CONT", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 798.6, "maximum": 1863.4, "gross_charge": 1331.0, "discounted_cash": 998.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 798.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1331.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1331.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1863.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1197.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1197.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1197.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1331.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1064.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1331.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1197.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1331.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 953.0, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1331.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1597.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1331.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1064.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 998.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1014.22, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1331.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM ABDOMEN 2 VWS", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 84.0, "maximum": 196.0, "gross_charge": 140.0, "discounted_cash": 105.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 196.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.24, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.68, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT THORACIC SPINE WO CONT", "code_information": [ { "code": "72128", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 775.8, "maximum": 1810.2, "gross_charge": 1293.0, "discounted_cash": 969.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 775.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1293.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1293.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1810.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1163.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1163.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1163.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1293.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1034.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1293.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1163.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1293.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 925.79, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1293.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1551.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1293.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1034.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 969.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 985.27, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1293.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT MAXILLOFACIAL W CONT", "code_information": [ { "code": "70487", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 768.6, "maximum": 1793.4, "gross_charge": 1281.0, "discounted_cash": 960.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 768.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1281.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1281.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1793.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1152.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1152.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1152.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1281.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1024.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1281.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1152.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1281.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 917.2, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1281.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1537.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1281.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1024.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 960.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 976.12, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1281.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI T SPINE WO CONTRAST", "code_information": [ { "code": "72146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1270.2, "maximum": 2963.8, "gross_charge": 2117.0, "discounted_cash": 1587.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1270.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2963.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1905.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1905.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1905.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1693.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1905.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1515.77, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2540.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1693.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1587.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1613.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2117.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US RETROPERITONEUM LTD", "code_information": [ { "code": "76775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 252.6, "maximum": 589.4, "gross_charge": 421.0, "discounted_cash": 315.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 421.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 421.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 589.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 421.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 421.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 421.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 301.44, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 421.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 421.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 315.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.8, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 421.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM ANKLE 2 VWS", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 79.8, "maximum": 186.2, "gross_charge": 133.0, "discounted_cash": 99.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 186.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.23, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 99.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.35, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT ABDOMEN W CONTRAST", "code_information": [ { "code": "74160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1182.6, "maximum": 2759.4, "gross_charge": 1971.0, "discounted_cash": 1478.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1182.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1971.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1971.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2759.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1773.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1773.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1773.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1971.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1576.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1971.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1773.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1971.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1411.24, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1971.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2365.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1971.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1576.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1478.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1501.9, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1971.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM ABDOMEN 1 VW", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.4, "maximum": 159.6, "gross_charge": 114.0, "discounted_cash": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 85.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM TIBIA FIBULA 2 VWS", "code_information": [ { "code": "73590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 76.2, "maximum": 177.8, "gross_charge": 127.0, "discounted_cash": 95.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 177.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 95.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM KNEE COMPL 4 + VWS", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 113.4, "maximum": 264.6, "gross_charge": 189.0, "discounted_cash": 141.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 264.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.32, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 141.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.02, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM FINGER(S) MIN 2 VWS", "code_information": [ { "code": "73140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 99.0, "maximum": 231.0, "gross_charge": 165.0, "discounted_cash": 123.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 231.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 123.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.73, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 165.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM FOOT 2 VWS", "code_information": [ { "code": "73620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.4, "maximum": 159.6, "gross_charge": 114.0, "discounted_cash": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 85.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM RIBS UNILAT W CHEST MIN 3 VWS", "code_information": [ { "code": "71101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 94.8, "maximum": 221.2, "gross_charge": 158.0, "discounted_cash": 118.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 158.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 158.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 221.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 158.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 158.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 158.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.13, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 158.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 158.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 118.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.4, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 158.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US ABD LIMITED", "code_information": [ { "code": "76705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 227.4, "maximum": 530.6, "gross_charge": 379.0, "discounted_cash": 284.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 227.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 379.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 379.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 530.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 341.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 341.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 341.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 379.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 379.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 341.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 379.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.36, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 379.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 454.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 379.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 284.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 379.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DUPLEX ABD PELVIS RETROPERITONEAL CMPL", "code_information": [ { "code": "93975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 714.0, "maximum": 1666.0, "gross_charge": 1190.0, "discounted_cash": 892.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 714.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1666.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1071.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1071.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1071.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 952.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1071.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 852.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1428.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 952.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 892.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 906.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT SOFT TISSUE NECK WO CON", "code_information": [ { "code": "70490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 706.2, "maximum": 1647.8, "gross_charge": 1177.0, "discounted_cash": 882.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 706.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1177.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1177.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1647.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1059.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1059.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1059.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1177.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 941.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1177.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1059.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1177.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 842.73, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1177.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1412.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1177.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 941.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 882.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 896.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1177.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SPINE CERV 2 OR 3 VWS", "code_information": [ { "code": "72040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 92.4, "maximum": 215.6, "gross_charge": 154.0, "discounted_cash": 115.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 215.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.26, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 115.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.35, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DUPLEX VENOUS EXT CMPL BILAT", "code_information": [ { "code": "93970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 609.6, "maximum": 1422.4, "gross_charge": 1016.0, "discounted_cash": 762.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 609.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1016.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1016.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1422.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 914.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 914.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 914.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1016.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 812.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1016.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 914.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1016.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 727.46, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1016.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1219.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1016.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 812.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 762.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 774.19, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1016.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM HIPS BILAT W PELV WHEN PERF MIN 5 VWS", "code_information": [ { "code": "73523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 150.0, "maximum": 350.0, "gross_charge": 250.0, "discounted_cash": 187.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 250.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 250.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 350.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 250.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 250.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 250.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.0, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 250.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 300.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 250.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 187.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.5, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 250.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM HIP UNILAT W PELV WHEN PERF MIN 4 VWS", "code_information": [ { "code": "73503", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 147.0, "maximum": 343.0, "gross_charge": 245.0, "discounted_cash": 183.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 343.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.42, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 294.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 183.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.69, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 245.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM CLAVICLE COMPL", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 78.0, "maximum": 182.0, "gross_charge": 130.0, "discounted_cash": 97.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 182.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.08, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 97.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.06, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US SCROTUM", "code_information": [ { "code": "76870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 269.4, "maximum": 628.6, "gross_charge": 449.0, "discounted_cash": 336.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 449.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 449.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 628.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 404.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 404.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 404.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 449.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 359.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 449.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 404.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 449.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 449.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 538.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 449.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 359.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 336.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.14, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 449.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SPINE THOR 2 VWS", "code_information": [ { "code": "72070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 73.8, "maximum": 172.2, "gross_charge": 123.0, "discounted_cash": 92.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 172.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.07, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 92.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.73, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM FEMUR MIN 2 VWS", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 85.8, "maximum": 200.2, "gross_charge": 143.0, "discounted_cash": 107.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 200.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.39, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 107.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.97, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 143.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM KNEE 1 OR 2 VWS", "code_information": [ { "code": "73560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 85.2, "maximum": 198.8, "gross_charge": 142.0, "discounted_cash": 106.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 198.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.67, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 106.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM HAND 2 VWS", "code_information": [ { "code": "73120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 74.4, "maximum": 173.6, "gross_charge": 124.0, "discounted_cash": 93.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 173.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.78, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.49, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US LMTD JNT OR FOC EVAL REAL TIME WIMAGE DOC", "code_information": [ { "code": "76882", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 108.0, "maximum": 252.0, "gross_charge": 180.0, "discounted_cash": 135.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 180.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 180.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 180.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 180.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.88, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 180.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 180.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 135.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.16, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 180.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM WRIST 2 VWS", "code_information": [ { "code": "73100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 84.0, "maximum": 196.0, "gross_charge": 140.0, "discounted_cash": 105.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 196.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.24, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.68, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM FOREARM 2 VWS", "code_information": [ { "code": "73090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 69.0, "maximum": 161.0, "gross_charge": 115.0, "discounted_cash": 86.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 161.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.34, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 86.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM ELBOW COMPL MIN 3 VWS", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 76.2, "maximum": 177.8, "gross_charge": 127.0, "discounted_cash": 95.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 177.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 95.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SPINE LUMB MIN 4 VWS", "code_information": [ { "code": "72110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 123.6, "maximum": 288.4, "gross_charge": 206.0, "discounted_cash": 154.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 206.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 206.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 288.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 206.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 206.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 206.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.5, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 206.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 206.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 154.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.97, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 206.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CHEMO SQ IM HORMONAL", "code_information": [ { "code": "96402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 91.2, "maximum": 212.8, "gross_charge": 152.0, "discounted_cash": 114.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 212.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.83, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM ABD SERIES 2 OR > ABD VIEWS AND SNGL VIEW CHEST", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 111.6, "maximum": 260.4, "gross_charge": 186.0, "discounted_cash": 139.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 186.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 186.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 260.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 186.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 186.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 186.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.18, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 186.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 186.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 139.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.73, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 186.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM HUMERUS MIN 2 VWS", "code_information": [ { "code": "73060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 78.0, "maximum": 182.0, "gross_charge": 130.0, "discounted_cash": 97.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 182.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.08, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 97.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.06, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US ABD AORTA SCREEN AAA", "code_information": [ { "code": "76706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 285.6, "maximum": 666.4, "gross_charge": 476.0, "discounted_cash": 357.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 476.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 476.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 666.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 476.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 476.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 476.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.82, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 476.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 571.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 476.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 357.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 362.71, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 476.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM ELBOW 2 VWS", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.4, "maximum": 159.6, "gross_charge": 114.0, "discounted_cash": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 85.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US PELVIC COMPLETE", "code_information": [ { "code": "76856", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 266.4, "maximum": 621.6, "gross_charge": 444.0, "discounted_cash": 333.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 444.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 444.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 621.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 444.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 444.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 444.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.9, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 444.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 532.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 444.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 333.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 338.33, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 444.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US PELVIC LIMITED", "code_information": [ { "code": "76857", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 250.8, "maximum": 585.2, "gross_charge": 418.0, "discounted_cash": 313.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 418.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 418.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 585.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 376.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 376.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 376.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 418.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 418.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 376.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 418.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 299.29, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 418.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 418.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 313.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 318.52, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 418.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM PELVIS 1 OR 2 VWS", "code_information": [ { "code": "72170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 78.0, "maximum": 182.0, "gross_charge": 130.0, "discounted_cash": 97.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 182.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.08, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 97.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.06, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM TOES MIN 2 VWS", "code_information": [ { "code": "73660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 73.8, "maximum": 172.2, "gross_charge": 123.0, "discounted_cash": 92.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 172.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.07, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 92.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.73, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM PELVIS COMPL MIN 3 VWS", "code_information": [ { "code": "72190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 96.6, "maximum": 225.4, "gross_charge": 161.0, "discounted_cash": 120.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 161.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 161.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 225.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 161.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 161.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 161.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.28, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 161.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 161.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 120.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.68, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 161.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM NECK SOFT TISSUE", "code_information": [ { "code": "70360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 73.8, "maximum": 172.2, "gross_charge": 123.0, "discounted_cash": 92.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 172.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.07, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 92.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.73, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SPINE CERV 4 OR 5 VWS", "code_information": [ { "code": "72050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 128.4, "maximum": 299.6, "gross_charge": 214.0, "discounted_cash": 160.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 214.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 214.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 299.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 214.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 214.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 214.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.22, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 214.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 256.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 214.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 160.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.07, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 214.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM RIBS BILAT W CHEST MIN 4 VWS", "code_information": [ { "code": "71111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 120.6, "maximum": 281.4, "gross_charge": 201.0, "discounted_cash": 150.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 201.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 201.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 281.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 201.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 201.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 201.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.92, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 201.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 201.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 150.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.16, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 201.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SPINE SINGLE VW", "code_information": [ { "code": "72020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 54.6, "maximum": 127.4, "gross_charge": 91.0, "discounted_cash": 68.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 127.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.16, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 68.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 91.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SKULL COMPL MIN 4 VWS", "code_information": [ { "code": "70260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 101.4, "maximum": 236.6, "gross_charge": 169.0, "discounted_cash": 126.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 236.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.0, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 126.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SPINE THOR 3 VWS", "code_information": [ { "code": "72072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 91.2, "maximum": 212.8, "gross_charge": 152.0, "discounted_cash": 114.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 212.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.83, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM RIBS UNILAT 2 VWS", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 84.0, "maximum": 196.0, "gross_charge": 140.0, "discounted_cash": 105.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 196.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.24, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.68, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SACROILIAC JNTS 3 + VWS", "code_information": [ { "code": "72202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 80.4, "maximum": 187.6, "gross_charge": 134.0, "discounted_cash": 100.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 187.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.94, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 100.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SACRUM COCCYX MIN 2 VWS", "code_information": [ { "code": "72220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 76.2, "maximum": 177.8, "gross_charge": 127.0, "discounted_cash": 95.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 177.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 95.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SCAPULA COMPL", "code_information": [ { "code": "73010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 73.8, "maximum": 172.2, "gross_charge": 123.0, "discounted_cash": 92.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 172.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.07, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 92.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.73, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM CALCANEUS MIN 2 VWS", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.4, "maximum": 159.6, "gross_charge": 114.0, "discounted_cash": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 85.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM EYE FOREIGN BODY", "code_information": [ { "code": "70030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 75.6, "maximum": 176.4, "gross_charge": 126.0, "discounted_cash": 94.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 176.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.22, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 94.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.01, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 126.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM MANDIBLE COMPL MIN 4 VWS", "code_information": [ { "code": "70110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 102.6, "maximum": 239.4, "gross_charge": 171.0, "discounted_cash": 128.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 171.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 239.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 171.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 171.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 171.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.44, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 171.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 171.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 128.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.3, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 171.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM FACIAL BONES < 3 VWS", "code_information": [ { "code": "70140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 72.6, "maximum": 169.4, "gross_charge": 121.0, "discounted_cash": 90.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 169.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.64, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 90.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 121.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM FACIAL BONES COMPL MIN 3 VWS", "code_information": [ { "code": "70150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 112.8, "maximum": 263.2, "gross_charge": 188.0, "discounted_cash": 141.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 188.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 188.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 263.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 188.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 188.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 188.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.61, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 188.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 188.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 141.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.26, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 188.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SINUSES PARANASAL < 3 VWS", "code_information": [ { "code": "70210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 76.2, "maximum": 177.8, "gross_charge": 127.0, "discounted_cash": 95.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 177.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 95.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SINUSES PARANASAL COMPL MIN 3 VWS", "code_information": [ { "code": "70220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 87.6, "maximum": 204.4, "gross_charge": 146.0, "discounted_cash": 109.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 204.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.54, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 109.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.25, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 146.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SKULL < 4 VWS", "code_information": [ { "code": "70250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 87.0, "maximum": 203.0, "gross_charge": 145.0, "discounted_cash": 108.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 145.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 145.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 203.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 145.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 145.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 145.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.82, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 145.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 145.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 108.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.49, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 145.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM TMJ OPEN CLOSED MOUTH UNILAT", "code_information": [ { "code": "70328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 84.0, "maximum": 196.0, "gross_charge": 140.0, "discounted_cash": 105.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 196.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.24, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 105.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.68, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM TMJ OPEN CLOSED MOUTH BILAT", "code_information": [ { "code": "70330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 135.6, "maximum": 316.4, "gross_charge": 226.0, "discounted_cash": 169.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 226.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 226.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 316.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 226.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 226.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 226.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.82, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 226.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 226.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 169.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.21, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 226.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM STERNUM MIN 2 VWS", "code_information": [ { "code": "71120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 78.0, "maximum": 182.0, "gross_charge": 130.0, "discounted_cash": 97.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 182.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.08, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 97.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.06, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM STERNUM JNT OR JNTS MIN 3 VWS", "code_information": [ { "code": "71130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 100.2, "maximum": 233.8, "gross_charge": 167.0, "discounted_cash": 125.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 167.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 167.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 233.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 167.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 167.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 167.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.57, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 167.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 167.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 125.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.25, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 167.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SPINE CERV 6 + VWS", "code_information": [ { "code": "72052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 154.2, "maximum": 359.8, "gross_charge": 257.0, "discounted_cash": 192.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 359.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.01, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 308.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 192.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.83, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SPINE ENTIRE THOR LUMB 1 VW", "code_information": [ { "code": "72081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 101.4, "maximum": 236.6, "gross_charge": 169.0, "discounted_cash": 126.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 236.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.0, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 126.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 169.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SPINE ENTIRE THOR LUMB 2 OR 3 VWS", "code_information": [ { "code": "72082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 178.2, "maximum": 415.8, "gross_charge": 297.0, "discounted_cash": 222.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 415.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.65, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 222.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.31, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SPINE LUMB BENDING VWS ONLY 2 OR 3 VWS", "code_information": [ { "code": "72120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 97.8, "maximum": 228.2, "gross_charge": 163.0, "discounted_cash": 122.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 228.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.71, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 122.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.21, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 163.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SACROILIAC JNTS < 3 VWS", "code_information": [ { "code": "72200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 80.4, "maximum": 187.6, "gross_charge": 134.0, "discounted_cash": 100.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 187.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.94, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 100.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 134.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM SHOULDER 1 VW", "code_information": [ { "code": "73020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.0, "maximum": 119.0, "gross_charge": 85.0, "discounted_cash": 63.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 119.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 63.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 85.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM AC JOINTS BILAT W WO WTS", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 86.4, "maximum": 201.6, "gross_charge": 144.0, "discounted_cash": 108.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 201.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.1, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 108.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.73, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 144.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM UPPER EXTREM INFANT MIN 2 VWS", "code_information": [ { "code": "73092", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 76.2, "maximum": 177.8, "gross_charge": 127.0, "discounted_cash": 95.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 177.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 95.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM HIP UNILAT W PELV WHEN PERF 1 VW", "code_information": [ { "code": "73501", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 74.4, "maximum": 173.6, "gross_charge": 124.0, "discounted_cash": 93.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 173.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.78, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 93.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.49, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM HIPS BILAT W PELV WHEN PERF 3 OR 4 VWS", "code_information": [ { "code": "73522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 127.2, "maximum": 296.8, "gross_charge": 212.0, "discounted_cash": 159.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 212.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 212.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 296.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 212.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 212.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 212.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.79, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 212.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 212.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 159.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.54, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 212.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM FEMUR 1 VW", "code_information": [ { "code": "73551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 69.0, "maximum": 161.0, "gross_charge": 115.0, "discounted_cash": 86.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 161.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.34, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 86.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM KNEE BOTH STANDING ANTEROPOSTERIOR", "code_information": [ { "code": "73565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 104.4, "maximum": 243.6, "gross_charge": 174.0, "discounted_cash": 130.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 174.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 174.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 243.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 174.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 174.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 174.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.58, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 174.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 174.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 130.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.59, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 174.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM LOWER EXTREM INFANT MIN 2 VWS", "code_information": [ { "code": "73592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 76.2, "maximum": 177.8, "gross_charge": 127.0, "discounted_cash": 95.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 177.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 95.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 127.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "RAD EXAM NOSE TO RECTUM FB SNGL VW CHILD", "code_information": [ { "code": "76010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.4, "maximum": 159.6, "gross_charge": 114.0, "discounted_cash": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 85.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "JOINT SURVEY SINGLE VW2+JOINT", "code_information": [ { "code": "77077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 98.4, "maximum": 229.6, "gross_charge": 164.0, "discounted_cash": 123.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 164.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 164.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 229.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 164.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 164.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 164.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.42, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 164.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 164.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 123.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.97, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 164.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BONE DENSITY DEXA AXIAL SKELET", "code_information": [ { "code": "77080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 156.0, "maximum": 364.0, "gross_charge": 260.0, "discounted_cash": 195.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 260.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 260.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 364.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 260.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 260.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 260.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.16, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 260.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 260.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 195.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.12, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 260.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT CERV SPINE WO THEN W CONT", "code_information": [ { "code": "72127", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1228.8, "maximum": 2867.2, "gross_charge": 2048.0, "discounted_cash": 1536.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1228.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2867.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1843.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1843.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1843.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1638.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1843.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1466.37, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2457.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1638.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1536.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1560.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CTA EXT LOWER W CONT +WO IF PERF", "code_information": [ { "code": "73706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1618.2, "maximum": 3775.8, "gross_charge": 2697.0, "discounted_cash": 2022.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1618.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2697.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2697.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3775.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2427.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2427.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2427.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2697.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2157.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2697.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2427.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2697.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1931.05, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2697.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3236.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2697.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2157.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2022.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2055.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2697.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT HEAD W CONTRAST", "code_information": [ { "code": "70460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 674.4, "maximum": 1573.6, "gross_charge": 1124.0, "discounted_cash": 843.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 674.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1573.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1011.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1011.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1011.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 899.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1011.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 804.78, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1348.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 899.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 843.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 856.49, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1124.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT ORBIT SELLA FOSSA EAR WO CONTRAST", "code_information": [ { "code": "70480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1005.6, "maximum": 2346.4, "gross_charge": 1676.0, "discounted_cash": 1257.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1005.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1676.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1676.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2346.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1508.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1508.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1508.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1676.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1340.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1676.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1508.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1676.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1200.02, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1676.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2011.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1676.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1340.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1257.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1277.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1676.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT ORBIT SELLA FOSSA EAR W CONTRAST", "code_information": [ { "code": "70481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1230.6, "maximum": 2871.4, "gross_charge": 2051.0, "discounted_cash": 1538.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1230.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2051.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2051.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2871.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1845.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1845.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1845.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2051.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1640.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2051.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1845.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2051.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1468.52, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2051.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2461.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2051.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1640.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1538.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1562.86, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2051.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT ORBIT SELLA FOSSA EAR WO THEN W CONTRAST", "code_information": [ { "code": "70482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1358.4, "maximum": 3169.6, "gross_charge": 2264.0, "discounted_cash": 1698.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1358.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2264.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2264.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3169.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2037.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2037.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2037.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2264.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1811.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2264.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2037.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2264.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1621.02, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2264.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2716.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2264.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1811.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1698.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1725.17, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2264.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT MAXILLOFACIAL WO W CONT", "code_information": [ { "code": "70488", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 960.0, "maximum": 2240.0, "gross_charge": 1600.0, "discounted_cash": 1200.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 960.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1600.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1600.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2240.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1440.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1440.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1440.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1600.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1280.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1600.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1440.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1600.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1145.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1600.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1920.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1600.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1280.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1200.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1219.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1600.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT SFT TISUE NECK WWO THEN W", "code_information": [ { "code": "70492", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1125.0, "maximum": 2625.0, "gross_charge": 1875.0, "discounted_cash": 1406.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1125.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1875.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1875.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2625.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1687.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1687.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1687.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1875.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1500.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1875.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1687.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1875.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1342.5, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1875.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2250.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1875.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1500.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1406.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1428.75, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1875.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT CERVICAL SPINE W CONTRAST", "code_information": [ { "code": "72126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 990.6, "maximum": 2311.4, "gross_charge": 1651.0, "discounted_cash": 1238.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 990.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1651.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1651.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2311.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1485.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1485.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1485.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1651.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1320.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1651.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1485.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1651.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1182.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1651.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1981.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1651.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1320.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1238.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1258.06, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1651.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT THORACIC SPINE W CONTRAST", "code_information": [ { "code": "72129", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 999.0, "maximum": 2331.0, "gross_charge": 1665.0, "discounted_cash": 1248.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 999.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1665.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1665.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2331.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1498.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1498.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1498.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1665.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1332.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1665.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1498.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1665.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1192.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1665.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1998.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1665.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1332.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1248.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1268.73, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1665.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT THOR SPINE WO THEN W CONT", "code_information": [ { "code": "72130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1230.6, "maximum": 2871.4, "gross_charge": 2051.0, "discounted_cash": 1538.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1230.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2051.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2051.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2871.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1845.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1845.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1845.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2051.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1640.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2051.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1845.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2051.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1468.52, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2051.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2461.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2051.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1640.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1538.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1562.86, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2051.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT LUMBAR SPINE W CONT", "code_information": [ { "code": "72132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 992.4, "maximum": 2315.6, "gross_charge": 1654.0, "discounted_cash": 1240.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 992.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1654.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1654.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2315.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1488.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1488.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1488.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1654.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1323.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1654.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1488.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1654.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1184.26, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1654.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1984.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1654.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1323.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1240.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1260.35, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1654.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT LUMBAR SPINE WO THEN WCON", "code_information": [ { "code": "72133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1222.8, "maximum": 2853.2, "gross_charge": 2038.0, "discounted_cash": 1528.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1222.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2038.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2038.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2853.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1834.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1834.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1834.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2038.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1630.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2038.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1834.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2038.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1459.21, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2038.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2445.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2038.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1630.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1528.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1552.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2038.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CTA PELVIS WCONT +WO IF PERF", "code_information": [ { "code": "72191", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1490.4, "maximum": 3477.6, "gross_charge": 2484.0, "discounted_cash": 1863.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2484.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2484.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3477.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2235.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2235.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2235.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2484.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1987.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2484.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2235.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2484.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1778.54, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2484.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2980.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2484.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1987.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1863.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1892.81, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2484.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT PELVIS W CONTRAST", "code_information": [ { "code": "72193", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1187.4, "maximum": 2770.6, "gross_charge": 1979.0, "discounted_cash": 1484.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1187.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1979.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1979.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2770.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1781.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1781.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1781.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1979.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1583.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1979.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1781.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1979.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1416.96, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1979.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2374.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1979.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1583.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1484.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1508.0, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1979.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT PELVIS WO THEN W CONT", "code_information": [ { "code": "72194", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1345.2, "maximum": 3138.8, "gross_charge": 2242.0, "discounted_cash": 1681.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1345.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3138.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2017.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2017.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2017.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1793.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2017.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1605.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2690.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1793.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1681.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1708.4, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT EXT UPPER WWO CONTRAST", "code_information": [ { "code": "73202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1342.8, "maximum": 3133.2, "gross_charge": 2238.0, "discounted_cash": 1678.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1342.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2238.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2238.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3133.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2014.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2014.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2014.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2238.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1790.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2238.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2014.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2238.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1602.41, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2238.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2685.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2238.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1790.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1678.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1705.36, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2238.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CTA EXT UPPER WCONT+WO IF PERF", "code_information": [ { "code": "73206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1477.2, "maximum": 3446.8, "gross_charge": 2462.0, "discounted_cash": 1846.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1477.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2462.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2462.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3446.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2215.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2215.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2215.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2462.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1969.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2462.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2215.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2462.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1762.79, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2462.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2954.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2462.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1969.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1846.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1876.04, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2462.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT EXT LOWER WO THEN W CONT", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1269.0, "maximum": 2961.0, "gross_charge": 2115.0, "discounted_cash": 1586.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1269.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2961.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1903.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1903.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1903.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1692.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1903.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1514.34, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2538.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1692.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1586.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1611.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2115.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT ABDOMEN WO CONTRAST", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 664.2, "maximum": 1549.8, "gross_charge": 1107.0, "discounted_cash": 830.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 664.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1549.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 996.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 996.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 996.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 885.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 996.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 792.61, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1328.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 885.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 830.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 843.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1107.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CT ABDOMEN WO THEN W CONT", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1340.4, "maximum": 3127.6, "gross_charge": 2234.0, "discounted_cash": 1675.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1340.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3127.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2010.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2010.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2010.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1787.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2010.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1599.54, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2680.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1787.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1675.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1702.31, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CTA ABD WCONT +WO IF PERF", "code_information": [ { "code": "74175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1486.8, "maximum": 3469.2, "gross_charge": 2478.0, "discounted_cash": 1858.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1486.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2478.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2478.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3469.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2230.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2230.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2230.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2478.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1982.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2478.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2230.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2478.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1774.25, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2478.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2973.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2478.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1982.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1858.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1888.24, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2478.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SURG 32555 THORACENTESIS W IMAGING", "code_information": [ { "code": "32555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 634.2, "maximum": 1479.8, "gross_charge": 1057.0, "discounted_cash": 792.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 634.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1057.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1057.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1479.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 951.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 951.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 951.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1057.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 845.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1057.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 951.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1057.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 756.81, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1057.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1268.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1057.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 845.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 792.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 805.43, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1057.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SURG 37799 PACLITAXEL INFUSION", "code_information": [ { "code": "37799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 274.2, "maximum": 639.8, "gross_charge": 457.0, "discounted_cash": 342.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 457.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 457.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 639.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 411.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 411.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 411.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 457.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 457.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 411.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 457.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 327.21, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 457.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 548.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 457.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 342.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.23, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 457.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MAMMO DX UNILAT INCL CAD", "code_information": [ { "code": "77065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 299.4, "maximum": 698.6, "gross_charge": 499.0, "discounted_cash": 374.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 299.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 499.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 499.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 698.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 449.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 449.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 449.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 499.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 499.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 449.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 499.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.28, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 499.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 598.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 499.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 374.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.24, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 499.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MAMMO DX BILAT INCL CAD", "code_information": [ { "code": "77066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 382.8, "maximum": 893.2, "gross_charge": 638.0, "discounted_cash": 478.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 382.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 638.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 638.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 893.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 574.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 574.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 574.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 638.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 510.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 638.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 574.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 638.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 456.81, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 638.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 765.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 638.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 510.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 478.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 486.16, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 638.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US CHEST", "code_information": [ { "code": "76604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 127.8, "maximum": 298.2, "gross_charge": 213.0, "discounted_cash": 159.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 213.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 213.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 298.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 213.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 213.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 213.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.51, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 213.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 213.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 159.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.31, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 213.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US UNILATERAL BREAST COMPLETE", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 232.2, "maximum": 541.8, "gross_charge": 387.0, "discounted_cash": 290.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 387.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 387.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 541.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 387.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 387.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 387.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.09, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 387.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 387.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 290.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 294.89, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 387.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US UNILATERAL BREAST LIMITED", "code_information": [ { "code": "76642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 178.2, "maximum": 415.8, "gross_charge": 297.0, "discounted_cash": 222.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 415.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.65, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 222.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.31, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US RETROPERITONEUM", "code_information": [ { "code": "76770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 289.8, "maximum": 676.2, "gross_charge": 483.0, "discounted_cash": 362.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 289.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 483.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 483.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 676.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 483.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 483.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 483.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 345.83, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 483.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 579.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 483.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 362.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.05, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 483.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US PREG UTER 1ST TRI SGL", "code_information": [ { "code": "76801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 240.0, "maximum": 560.0, "gross_charge": 400.0, "discounted_cash": 300.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 400.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 400.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 400.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 400.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 286.4, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 400.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 480.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 400.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 300.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 304.8, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 400.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US PG UTR 2-3TRI SGL 1ST", "code_information": [ { "code": "76805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 303.0, "maximum": 707.0, "gross_charge": 505.0, "discounted_cash": 378.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 505.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 505.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 707.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 454.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 454.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 454.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 505.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 404.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 505.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 454.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 505.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 361.58, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 505.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 606.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 505.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 404.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 378.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 384.81, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 505.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US OB REAL TIME LTD", "code_information": [ { "code": "76815", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 203.4, "maximum": 474.6, "gross_charge": 339.0, "discounted_cash": 254.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 339.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 339.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 474.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 305.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 305.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 305.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 339.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 339.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 305.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 339.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 242.72, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 339.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 339.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 254.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.32, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 339.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US PREG UTERUS FOLLOWUP PER FETUS", "code_information": [ { "code": "76816", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 235.8, "maximum": 550.2, "gross_charge": 393.0, "discounted_cash": 294.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 393.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 393.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 550.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 353.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 353.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 353.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 393.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 314.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 393.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 353.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 393.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.39, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 393.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 471.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 393.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 314.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 294.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 299.47, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 393.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US PG UTR TRANSVAG", "code_information": [ { "code": "76817", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 195.0, "maximum": 455.0, "gross_charge": 325.0, "discounted_cash": 243.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 325.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 325.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 455.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 292.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 292.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 292.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 325.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 325.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 292.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 325.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.7, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 325.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 390.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 325.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 243.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.65, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 325.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US FETAL BPP WO NST", "code_information": [ { "code": "76819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 159.6, "maximum": 372.4, "gross_charge": 266.0, "discounted_cash": 199.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 266.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 266.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 372.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 239.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 239.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 239.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 266.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 266.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 239.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 266.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.46, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 266.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 319.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 266.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 199.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.69, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 266.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "US TRANSVAGINAL", "code_information": [ { "code": "76830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 295.2, "maximum": 688.8, "gross_charge": 492.0, "discounted_cash": 369.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 492.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 492.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 688.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 442.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 442.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 442.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 492.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 393.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 492.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 442.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 492.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 492.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 590.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 492.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 393.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 369.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.9, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 492.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SCREEN DIGITAL BREAST TOMOSYNTHESIS", "code_information": [ { "code": "77063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 81.6, "maximum": 190.4, "gross_charge": 136.0, "discounted_cash": 102.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 190.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.38, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 102.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 136.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MAMMO SCREEN BILAT INCL CAD", "code_information": [ { "code": "77067", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 316.2, "maximum": 737.8, "gross_charge": 527.0, "discounted_cash": 395.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 737.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 474.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 474.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 474.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 474.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.33, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 632.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 395.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.57, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MAMMO SCREEN UNILAT INCL CAD M52", "code_information": [ { "code": "77067", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 316.2, "maximum": 737.8, "gross_charge": 527.0, "discounted_cash": 395.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 737.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 474.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 474.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 474.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 474.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.33, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 632.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 395.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.57, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI CHEST WO CONTRAST", "code_information": [ { "code": "71550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1985.4, "maximum": 4632.6, "gross_charge": 3309.0, "discounted_cash": 2481.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1985.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3309.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3309.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4632.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2978.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2978.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2978.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3309.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2647.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3309.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2978.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3309.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2369.24, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3309.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3970.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3309.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2647.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2481.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2521.46, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3309.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI CHEST WO THEN W CONT", "code_information": [ { "code": "71552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2707.2, "maximum": 6316.8, "gross_charge": 4512.0, "discounted_cash": 3384.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2707.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 4512.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 4512.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 6316.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4060.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4060.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 4060.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 4512.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3609.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 4512.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4060.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 4512.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 3230.59, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 4512.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 5414.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 4512.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3609.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 3384.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3438.14, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 4512.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI PELVIS WO CONTRAST", "code_information": [ { "code": "72195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1657.2, "maximum": 3866.8, "gross_charge": 2762.0, "discounted_cash": 2071.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1657.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3866.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2485.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2485.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2485.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2209.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2485.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1977.59, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3314.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2209.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2071.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2104.64, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI PELVIS WO THEN W CONT", "code_information": [ { "code": "72197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2151.0, "maximum": 5019.0, "gross_charge": 3585.0, "discounted_cash": 2688.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2151.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 5019.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3226.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3226.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 3226.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2868.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3226.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2566.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 4302.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2868.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2688.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2731.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI UP EXT WO CONT", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1740.6, "maximum": 4061.4, "gross_charge": 2901.0, "discounted_cash": 2175.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1740.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2901.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2901.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4061.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2610.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2610.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2610.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2901.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2320.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2901.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2610.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2901.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2077.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2901.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3481.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2901.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2320.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2175.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2210.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2901.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI UPPER EXT WO THEN W CONT", "code_information": [ { "code": "73220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2274.0, "maximum": 5306.0, "gross_charge": 3790.0, "discounted_cash": 2842.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2274.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3790.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3790.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 5306.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3411.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3411.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 3411.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3790.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3032.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3790.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3411.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3790.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2713.64, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3790.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 4548.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3790.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3032.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2842.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2887.98, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3790.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI UPPER EXT JT WO THEN W CONT", "code_information": [ { "code": "73223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2083.8, "maximum": 4862.2, "gross_charge": 3473.0, "discounted_cash": 2604.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2083.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3473.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3473.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4862.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3125.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3125.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 3125.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3473.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2778.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3473.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3125.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3473.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2486.67, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3473.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 4167.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3473.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2778.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2604.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2646.43, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3473.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI LOWER EXT WO THEN W CONT", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2151.0, "maximum": 5019.0, "gross_charge": 3585.0, "discounted_cash": 2688.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2151.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 5019.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3226.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3226.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 3226.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2868.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3226.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2566.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 4302.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2868.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2688.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2731.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI ABDOMEN WO CONTRAST", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 916.2, "maximum": 2137.8, "gross_charge": 1527.0, "discounted_cash": 1145.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 916.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2137.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1374.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1374.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1374.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1221.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1374.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1093.33, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1832.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1221.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1145.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1163.57, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1527.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRI T SPINE W CONTRAST", "code_information": [ { "code": "72147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1376.4, "maximum": 3211.6, "gross_charge": 2294.0, "discounted_cash": 1720.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1376.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2294.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2294.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3211.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2064.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2064.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2064.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2294.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1835.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2294.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2064.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2294.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1642.5, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2294.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2752.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2294.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1835.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1720.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1748.03, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2294.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRA NECK WO CONTRAST", "code_information": [ { "code": "70547", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1119.6, "maximum": 2612.4, "gross_charge": 1866.0, "discounted_cash": 1399.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1119.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1866.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1866.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2612.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1679.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1679.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1679.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1866.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1492.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1866.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1679.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1866.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1336.06, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1866.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2239.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1866.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1492.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1399.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1421.89, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1866.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MRA NECK WO THEN W CONT", "code_information": [ { "code": "70549", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1823.4, "maximum": 4254.6, "gross_charge": 3039.0, "discounted_cash": 2279.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1823.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3039.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3039.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4254.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2735.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2735.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2735.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3039.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2431.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3039.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2735.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3039.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2175.92, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3039.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3646.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3039.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2431.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2279.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2315.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3039.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DOPPLER SPECTRAL DISPLAY COMP", "code_information": [ { "code": "93320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 93.0, "maximum": 217.0, "gross_charge": 155.0, "discounted_cash": 116.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 155.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 155.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 155.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 155.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 155.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.98, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 155.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 155.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 116.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 155.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DOPPLER LIMITED", "code_information": [ { "code": "93321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 51.6, "maximum": 120.4, "gross_charge": 86.0, "discounted_cash": 64.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 120.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.58, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 64.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 86.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "COLOR FLOW VEL MAP", "code_information": [ { "code": "93325", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 57.6, "maximum": 134.4, "gross_charge": 96.0, "discounted_cash": 72.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 134.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.74, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 72.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.15, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 96.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MYOCRD STRAIN IMG SPCKL TRCK ADD ON", "code_information": [ { "code": "93356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 105.6, "maximum": 246.4, "gross_charge": 176.0, "discounted_cash": 132.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 176.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 176.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 246.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 176.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 176.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 176.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.02, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 176.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 176.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 176.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ECHO 2-D LIMITED", "code_information": [ { "code": "93308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 244.8, "maximum": 571.2, "gross_charge": 408.0, "discounted_cash": 306.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 408.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 408.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 571.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 408.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 326.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 408.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 408.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 292.13, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 408.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 489.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 408.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 326.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 306.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 310.9, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 408.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DUPLEX ABD PELVIS RETROPERITONEAL CMPL", "code_information": [ { "code": "93975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 714.0, "maximum": 1666.0, "gross_charge": 1190.0, "discounted_cash": 892.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 714.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1666.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1071.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1071.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1071.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 952.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1071.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 852.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1428.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 952.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 892.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 906.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1190.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "CANALITH REPOSITION PROC 95992", "code_information": [ { "code": "95992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 137.4, "maximum": 320.6, "gross_charge": 229.0, "discounted_cash": 171.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 320.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.96, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 171.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.5, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TRACTION MECHANICAL 97012", "code_information": [ { "code": "97012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 42.6, "maximum": 99.4, "gross_charge": 71.0, "discounted_cash": 53.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 71.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 71.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 99.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 71.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 71.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 71.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.84, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 71.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 71.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 53.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 71.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ELEC STIM UNATTENDED 97014", "code_information": [ { "code": "97014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 42.0, "maximum": 98.0, "gross_charge": 70.0, "discounted_cash": 52.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 98.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.12, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 52.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.34, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 70.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "IONTOPHORESIS 15 MIN 97033", "code_information": [ { "code": "97033", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 57.0, "maximum": 133.0, "gross_charge": 95.0, "discounted_cash": 71.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 133.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.02, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 71.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.39, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 95.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PHONOPHORESIS 15 MIN 97035", "code_information": [ { "code": "97035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 36.6, "maximum": 85.4, "gross_charge": 61.0, "discounted_cash": 45.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 85.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.68, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 45.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "NEUROMUSC RE ED EA 15MIN 97112", "code_information": [ { "code": "97112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 92.4, "maximum": 215.6, "gross_charge": 154.0, "discounted_cash": 115.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 215.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.26, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 115.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.35, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 154.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GAIT TRAINING 15 MIN 97116", "code_information": [ { "code": "97116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 79.2, "maximum": 184.8, "gross_charge": 132.0, "discounted_cash": 99.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 184.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.51, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 99.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SELFCARE HM TRNG 15M SEP PROC M59", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 43.8, "maximum": 102.2, "gross_charge": 73.0, "discounted_cash": 54.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 102.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 54.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.63, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 73.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "WHLCHR MGMT 15 MIN 97542", "code_information": [ { "code": "97542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 88.2, "maximum": 205.8, "gross_charge": 147.0, "discounted_cash": 110.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 147.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 147.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 205.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 147.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 147.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 147.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.25, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 147.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 147.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 110.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.01, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 147.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "NONSELCT DEBRIDMNT LEV 4", "code_information": [ { "code": "97602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 250.2, "maximum": 583.8, "gross_charge": 417.0, "discounted_cash": 312.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 417.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 417.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 583.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 417.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 333.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 417.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 417.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 298.57, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 417.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 417.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 333.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 312.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.75, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 417.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PHYSICAL PERFORMANCE TEST 97750", "code_information": [ { "code": "97750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 94.8, "maximum": 221.2, "gross_charge": 158.0, "discounted_cash": 118.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 158.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 158.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 221.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 158.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 158.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 158.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.13, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 158.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 158.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 118.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.4, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 158.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PT EVAL LOW COMPLEXITY 97161", "code_information": [ { "code": "97161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 220.8, "maximum": 515.2, "gross_charge": 368.0, "discounted_cash": 276.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 368.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 368.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 515.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 368.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 294.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 368.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 368.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 263.49, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 368.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 441.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 368.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 294.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 276.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 280.42, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 368.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PT EVAL MODERATE COMPLEXITY 97162", "code_information": [ { "code": "97162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 234.6, "maximum": 547.4, "gross_charge": 391.0, "discounted_cash": 293.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 391.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 391.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 547.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 391.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 391.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 391.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.96, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 391.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 469.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 391.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 293.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 297.94, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 391.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PT EVAL HIGH COMPLEXITY 97163", "code_information": [ { "code": "97163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 247.8, "maximum": 578.2, "gross_charge": 413.0, "discounted_cash": 309.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 413.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 413.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 578.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 413.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 330.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 413.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 413.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.71, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 413.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 495.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 413.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 330.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 309.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 314.71, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 413.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PT RE-EVAL EST PLAN CARE 97164", "code_information": [ { "code": "97164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 152.4, "maximum": 355.6, "gross_charge": 254.0, "discounted_cash": 190.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 254.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 355.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 254.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 254.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 254.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.86, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 254.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 304.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 254.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 190.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.55, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 254.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "PARAFFIN BATH 97018", "code_information": [ { "code": "97018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 28.8, "maximum": 67.2, "gross_charge": 48.0, "discounted_cash": 36.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 67.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.37, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 36.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 48.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ELEC STIM MAN PER 15 MIN 97032", "code_information": [ { "code": "97032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 49.8, "maximum": 116.2, "gross_charge": 83.0, "discounted_cash": 62.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 116.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.43, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 62.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.25, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 83.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ULTRASOUND 15 MIN 97035", "code_information": [ { "code": "97035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 36.6, "maximum": 85.4, "gross_charge": 61.0, "discounted_cash": 45.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 85.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.68, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 45.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 61.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "THER EXERCISE EA 15 MIN 97110", "code_information": [ { "code": "97110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 85.2, "maximum": 198.8, "gross_charge": 142.0, "discounted_cash": 106.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 198.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.67, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 106.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.2, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 142.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "THER INT COG FUNC 1ST 15MIN 97129", "code_information": [ { "code": "97129", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.6, "maximum": 141.4, "gross_charge": 101.0, "discounted_cash": 75.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 141.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.32, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 75.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 101.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "MANUAL THERAPY 15 MIN 97140", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 78.0, "maximum": 182.0, "gross_charge": 130.0, "discounted_cash": 97.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 182.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.08, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 97.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.06, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 130.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "THER ACTIVITIES EA15 MIN 97530", "code_information": [ { "code": "97530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 105.6, "maximum": 246.4, "gross_charge": 176.0, "discounted_cash": 132.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 176.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 176.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 246.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 176.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 176.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 176.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.02, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 176.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 176.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 132.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 176.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SENS INTEGRATION 15 MIN 97533", "code_information": [ { "code": "97533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 113.4, "maximum": 264.6, "gross_charge": 189.0, "discounted_cash": 141.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 264.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.32, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 141.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.02, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 189.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SLFCR HOME MGMT TRN15MIN 97535", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 91.2, "maximum": 212.8, "gross_charge": 152.0, "discounted_cash": 114.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 212.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.83, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DEBRIDE SELECT OPEN WOUND FIRST 20 SQCM OR LESS 97597", "code_information": [ { "code": "97597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 257.4, "maximum": 600.6, "gross_charge": 429.0, "discounted_cash": 321.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 429.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 429.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 600.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 429.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 343.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 429.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 429.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.16, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 429.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 429.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 343.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 321.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 326.9, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 429.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DEBRIDE SELECT OPEN WOUND EACH ADDL 20 SQCM 97598", "code_information": [ { "code": "97598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 246.0, "maximum": 574.0, "gross_charge": 410.0, "discounted_cash": 307.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 410.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 410.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 574.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 410.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 328.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 410.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 410.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 293.56, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 410.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 410.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 328.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 307.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.42, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 410.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ORTHOTICS MGMT&TRAIN INITIAL 15MIN 97760", "code_information": [ { "code": "97760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 127.2, "maximum": 296.8, "gross_charge": 212.0, "discounted_cash": 159.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 212.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 212.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 296.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 212.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 212.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 212.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.79, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 212.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 212.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 159.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.54, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 212.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OT EVAL LOW COMPLEXITY 97165", "code_information": [ { "code": "97165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 236.4, "maximum": 551.6, "gross_charge": 394.0, "discounted_cash": 295.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 394.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 394.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 551.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 394.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 315.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 394.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 394.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.1, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 394.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 472.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 394.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 315.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 295.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 300.23, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 394.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OT EVAL MODERATE COMPLEXITY 97166", "code_information": [ { "code": "97166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 252.6, "maximum": 589.4, "gross_charge": 421.0, "discounted_cash": 315.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 421.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 421.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 589.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 421.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 421.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 421.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 301.44, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 421.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 421.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 315.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.8, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 421.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OT EVAL HIGH COMPLEXITY 97167", "code_information": [ { "code": "97167", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 275.4, "maximum": 642.6, "gross_charge": 459.0, "discounted_cash": 344.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 459.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 459.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 642.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 459.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 459.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 459.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 328.64, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 459.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 550.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 459.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 344.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.76, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 459.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "OT RE-EVAL EST PLAN CARE 97168", "code_information": [ { "code": "97168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 162.6, "maximum": 379.4, "gross_charge": 271.0, "discounted_cash": 203.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 379.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 203.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.5, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 271.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SPEECH THERAPY TX 92507", "code_information": [ { "code": "92507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 208.8, "maximum": 487.2, "gross_charge": 348.0, "discounted_cash": 261.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 348.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 348.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 487.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 348.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 348.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 348.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.17, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 348.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 417.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 348.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 261.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 265.18, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 348.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "DYSPHAGIA THERAPY 92526", "code_information": [ { "code": "92526", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 228.0, "maximum": 532.0, "gross_charge": 380.0, "discounted_cash": 285.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 380.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 380.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 532.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 380.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 304.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 380.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 380.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 272.08, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 380.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 456.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 380.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 304.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 285.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 289.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 380.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SPEECH EVAL FLUENCY 92521", "code_information": [ { "code": "92521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 351.6, "maximum": 820.4, "gross_charge": 586.0, "discounted_cash": 439.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 586.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 586.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 820.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 586.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 468.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 586.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 586.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 419.58, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 586.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 703.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 586.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 468.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 439.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 446.53, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 586.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "SPEECH EVAL LANG COMP EXPRESSION 92523", "code_information": [ { "code": "92523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 604.8, "maximum": 1411.2, "gross_charge": 1008.0, "discounted_cash": 756.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 604.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1008.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1008.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1411.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 907.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 907.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 907.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1008.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 806.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1008.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 907.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1008.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 721.73, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1008.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1209.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1008.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 806.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 756.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 768.1, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1008.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "EVAL ORAL & PHARYNGEAL SWALLOW 92610", "code_information": [ { "code": "92610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 233.4, "maximum": 544.6, "gross_charge": 389.0, "discounted_cash": 291.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 389.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 389.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 544.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 389.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 311.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 389.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 389.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.52, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 389.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 466.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 389.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 311.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 291.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 296.42, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 389.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "VIDEO SWALLOW W XRAY 92611", "code_information": [ { "code": "92611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 241.2, "maximum": 562.8, "gross_charge": 402.0, "discounted_cash": 301.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 402.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 402.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 562.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 361.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 361.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 361.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 402.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 402.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 361.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 402.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.83, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 402.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 482.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 402.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 301.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 306.32, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 402.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "BASIC VESTIBULAR EVAL", "code_information": [ { "code": "92540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 82.8, "maximum": 193.2, "gross_charge": 138.0, "discounted_cash": 103.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 193.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.81, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 103.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.16, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 138.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 10060 I&D SKIN ABSCESS SMPL", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 10061 I&D SKIN ABSCESS COMPL", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 468.0, "maximum": 1092.0, "gross_charge": 780.0, "discounted_cash": 585.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 468.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 780.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 780.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1092.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 702.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 702.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 702.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 780.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 624.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 780.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 702.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 780.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 558.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 780.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 936.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 780.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 624.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 585.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 594.36, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 780.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 10080 I&D PILONIDAL CYST SMPL", "code_information": [ { "code": "10080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 745.2, "maximum": 1738.8, "gross_charge": 1242.0, "discounted_cash": 931.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1738.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 889.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 931.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 946.4, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 10120 INC&REMV FB SMPL", "code_information": [ { "code": "10120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 11042 DEBR SKN SUBQ TISS 20 CM <", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 11055 PARING LESN BENIGN", "code_information": [ { "code": "11055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 11056 TRIM SKIN LESN 2 TO 4", "code_information": [ { "code": "11056", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 11402 EXC BND LSN 1.1-2.0 CM TAL", "code_information": [ { "code": "11402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 745.2, "maximum": 1738.8, "gross_charge": 1242.0, "discounted_cash": 931.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1738.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 889.27, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 993.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 931.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 946.4, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1242.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 11730 REMV OF NAIL PLATE", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 11740 DRAIN BLOOD UNDER NAIL", "code_information": [ { "code": "11740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 134.4, "maximum": 313.6, "gross_charge": 224.0, "discounted_cash": 168.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 313.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.38, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 168.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.69, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 224.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 11750 REMV OF NAIL BED", "code_information": [ { "code": "11750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 419.4, "maximum": 978.6, "gross_charge": 699.0, "discounted_cash": 524.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 419.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 699.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 699.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 978.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 629.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 629.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 629.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 699.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 559.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 699.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 629.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 699.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 699.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 838.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 699.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 559.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 524.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 532.64, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 699.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 11760 RPR OF NAIL BED", "code_information": [ { "code": "11760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 628.2, "maximum": 1465.8, "gross_charge": 1047.0, "discounted_cash": 785.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 628.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1465.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 837.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 749.65, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1256.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 837.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 785.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 797.81, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12001 RPR SUPERFCL WND 2.5CM OR<", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 215.4, "maximum": 502.6, "gross_charge": 359.0, "discounted_cash": 269.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 502.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 269.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12002 RPR SUPERFCL WND 2.6-7.5CM", "code_information": [ { "code": "12002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 215.4, "maximum": 502.6, "gross_charge": 359.0, "discounted_cash": 269.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 502.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 269.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12004 RPR SUPRFCL WND 7.6-12.5CM", "code_information": [ { "code": "12004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 215.4, "maximum": 502.6, "gross_charge": 359.0, "discounted_cash": 269.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 502.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 269.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12005 RPR SUPRFL WND 12.6-20.0CM", "code_information": [ { "code": "12005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 215.4, "maximum": 502.6, "gross_charge": 359.0, "discounted_cash": 269.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 502.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 269.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12006 RPR SUPRFL WND 20.1-30.0CM", "code_information": [ { "code": "12006", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 215.4, "maximum": 502.6, "gross_charge": 359.0, "discounted_cash": 269.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 502.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 269.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12007 RPR SUPERFCL WND >30CM", "code_information": [ { "code": "12007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 215.4, "maximum": 502.6, "gross_charge": 359.0, "discounted_cash": 269.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 502.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 269.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12011 RPR SUPERFCL WND 2.5CM OR<", "code_information": [ { "code": "12011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 215.4, "maximum": 502.6, "gross_charge": 359.0, "discounted_cash": 269.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 502.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 269.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12013 RPR SUPERFCL WND 2.6-5.0CM", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 215.4, "maximum": 502.6, "gross_charge": 359.0, "discounted_cash": 269.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 502.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 269.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12014 RPR SUPERFCL WND 5.1-7.5CM", "code_information": [ { "code": "12014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 215.4, "maximum": 502.6, "gross_charge": 359.0, "discounted_cash": 269.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 502.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 269.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12015 RPR SUPERFL WND 7.6-12.5CM", "code_information": [ { "code": "12015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 215.4, "maximum": 502.6, "gross_charge": 359.0, "discounted_cash": 269.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 502.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 269.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12016 SMPL RPR FACE 12.6-20.0 CM", "code_information": [ { "code": "12016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 215.4, "maximum": 502.6, "gross_charge": 359.0, "discounted_cash": 269.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 502.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 269.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12017 RPR SUPRFL WND 20.1-30.0CM", "code_information": [ { "code": "12017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 215.4, "maximum": 502.6, "gross_charge": 359.0, "discounted_cash": 269.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 502.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 269.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12018 SMPL RPR LAC FCE EARS LID NSE LPS MOUTH>30.0CM", "code_information": [ { "code": "12018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 215.4, "maximum": 502.6, "gross_charge": 359.0, "discounted_cash": 269.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 502.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 269.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.56, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 359.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12031 LYR CLSR OF WND 2.5CM OR <", "code_information": [ { "code": "12031", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12032 LYR CLSR OF WND 2.6-7.5CM", "code_information": [ { "code": "12032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12034 LYR CLSR OF WND 7.6-12.5CM", "code_information": [ { "code": "12034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12035 LYR CLSR OF WD 12.6-20.0CM", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12042 LYR CLSR WND 2.6-7.5CM NHF", "code_information": [ { "code": "12042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12044 LYR CLSR WD 7.6-12.5CM NHF", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 628.2, "maximum": 1465.8, "gross_charge": 1047.0, "discounted_cash": 785.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 628.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1465.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 837.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 749.65, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1256.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 837.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 785.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 797.81, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12045 LYR CLR WD 12.6-20.0CM NHF", "code_information": [ { "code": "12045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 628.8, "maximum": 1467.2, "gross_charge": 1048.0, "discounted_cash": 786.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 628.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1467.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 943.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 943.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 943.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 838.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 943.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 750.37, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1257.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 838.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 786.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 798.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1048.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12051 LYR CLSR OF WND 2.5CM OR <", "code_information": [ { "code": "12051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12052 LYR CLSR OF WND 2.6-5.0CM", "code_information": [ { "code": "12052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 12054 LYR CLSR OF WND 7.6-12.5CM", "code_information": [ { "code": "12054", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 13121 RPR CMPLX WND 2.6-7.5 CM", "code_information": [ { "code": "13121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 628.2, "maximum": 1465.8, "gross_charge": 1047.0, "discounted_cash": 785.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 628.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1465.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 837.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 749.65, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1256.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 837.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 785.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 797.81, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 13122 RPR CMPLX EACH ADD 5CM", "code_information": [ { "code": "13122", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 35.4, "maximum": 82.6, "gross_charge": 59.0, "discounted_cash": 44.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 82.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.24, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 44.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 13132 RPR CPX WD OR LSN 2.6-7.5CM", "code_information": [ { "code": "13132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 628.2, "maximum": 1465.8, "gross_charge": 1047.0, "discounted_cash": 785.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 628.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1465.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 837.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 749.65, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1256.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 837.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 785.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 797.81, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1047.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 13133 RPR CX WD OR LN EA AD 5CM <", "code_information": [ { "code": "13133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 35.4, "maximum": 82.6, "gross_charge": 59.0, "discounted_cash": 44.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 82.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.24, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 44.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 16020 DRSG DEBRIDEMENT BURN<5% BSA", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 16030 BURN DRESS DEBRID LARGE", "code_information": [ { "code": "16030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 414.0, "maximum": 966.0, "gross_charge": 690.0, "discounted_cash": 517.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 966.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.04, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 828.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 517.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 690.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 17999 SKIN MUC MEM SUBQ TISSUE UNLISTED PROCEDURE", "code_information": [ { "code": "17999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.6, "maximum": 505.4, "gross_charge": 361.0, "discounted_cash": 270.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 270.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 20520 RMVL FB MUSC TEND SMPL", "code_information": [ { "code": "20520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1809.0, "maximum": 4221.0, "gross_charge": 3015.0, "discounted_cash": 2261.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1809.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 3015.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 3015.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4221.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2713.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2713.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2713.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3015.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2412.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3015.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2713.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 3015.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2158.74, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3015.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3618.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 3015.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2412.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2261.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2297.43, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 3015.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 20610 ASP INJ JOINT BURSA MAJOR WO US GUID", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 325.8, "maximum": 760.2, "gross_charge": 543.0, "discounted_cash": 407.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 760.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.79, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 651.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 407.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.77, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 543.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 23500 CLSD TX CLAVICLE FX", "code_information": [ { "code": "23500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 295.8, "maximum": 690.2, "gross_charge": 493.0, "discounted_cash": 369.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 690.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.99, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 369.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 23575 CLSD TX SCAPULA FX WMANIP", "code_information": [ { "code": "23575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1707.6, "maximum": 3984.4, "gross_charge": 2846.0, "discounted_cash": 2134.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1707.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2846.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2846.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3984.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2561.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2561.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2561.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2846.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2276.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2846.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2561.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2846.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2037.74, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2846.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3415.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2846.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2276.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2134.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2168.65, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2846.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 23650 CLSD TX SHOULDER DISLOC W MANIP WO ANES", "code_information": [ { "code": "23650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 295.8, "maximum": 690.2, "gross_charge": 493.0, "discounted_cash": 369.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 690.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.99, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 369.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 24600 CLSD TX ELBOW DISLOC W/O ANES", "code_information": [ { "code": "24600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 295.8, "maximum": 690.2, "gross_charge": 493.0, "discounted_cash": 369.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 690.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.99, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 369.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 24640 CLSD TX RADIAL HEAD ELB W MANIP", "code_information": [ { "code": "24640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 295.8, "maximum": 690.2, "gross_charge": 493.0, "discounted_cash": 369.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 690.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.99, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 369.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 25605 CLSD TX DISTAL RADIAL WMANIP", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1727.4, "maximum": 4030.6, "gross_charge": 2879.0, "discounted_cash": 2159.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1727.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2879.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2879.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4030.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2591.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2591.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2591.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2879.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2303.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2879.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2591.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2879.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2061.36, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2879.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3454.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2879.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2303.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2159.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2193.8, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2879.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 26410 RPR HAND TENDOR", "code_information": [ { "code": "26410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3208.2, "maximum": 7485.8, "gross_charge": 5347.0, "discounted_cash": 4010.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3208.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 5347.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 5347.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 7485.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4812.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4812.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 4812.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 5347.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4277.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 5347.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4812.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 5347.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 3828.45, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 5347.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 6416.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 5347.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4277.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 4010.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4074.41, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 5347.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 26700 CLSD TX KNUCKLE DISLOC W MANIP", "code_information": [ { "code": "26700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 295.8, "maximum": 690.2, "gross_charge": 493.0, "discounted_cash": 369.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 690.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.99, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 369.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 26740 CLSD TX FINGER FX", "code_information": [ { "code": "26740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 295.8, "maximum": 690.2, "gross_charge": 493.0, "discounted_cash": 369.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 690.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.99, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 369.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 26742 CLSD TX ARTICULAR FX W MC/IP JNT W MANIP EA", "code_information": [ { "code": "26742", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1727.4, "maximum": 4030.6, "gross_charge": 2879.0, "discounted_cash": 2159.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1727.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2879.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2879.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 4030.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2591.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2591.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2591.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2879.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2303.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2879.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2591.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2879.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2061.36, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2879.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3454.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2879.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2303.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2159.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2193.8, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2879.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 26770 CLSD TX FINGER DISLOC W MANIP", "code_information": [ { "code": "26770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 295.8, "maximum": 690.2, "gross_charge": 493.0, "discounted_cash": 369.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 690.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.99, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 369.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 27780 CLSD TX PROX FIB FX WO MANIP", "code_information": [ { "code": "27780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 295.8, "maximum": 690.2, "gross_charge": 493.0, "discounted_cash": 369.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 690.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.99, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 369.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 27788 CLSD TX ANKLE FX WMANIP", "code_information": [ { "code": "27788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 295.8, "maximum": 690.2, "gross_charge": 493.0, "discounted_cash": 369.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 690.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.99, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 369.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 27818 CLSD TX TRIMAL WMANIP", "code_information": [ { "code": "27818", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1707.6, "maximum": 3984.4, "gross_charge": 2846.0, "discounted_cash": 2134.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1707.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2846.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2846.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3984.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2561.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2561.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2561.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2846.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2276.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2846.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2561.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2846.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 2037.74, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2846.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3415.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2846.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2276.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2134.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2168.65, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2846.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 27840 CLSD TX ANKLE DISLOC WO ANES", "code_information": [ { "code": "27840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 295.8, "maximum": 690.2, "gross_charge": 493.0, "discounted_cash": 369.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 690.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.99, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 369.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.67, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 493.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 29105 APPL SPLINT LONG ARM", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 177.6, "maximum": 414.4, "gross_charge": 296.0, "discounted_cash": 222.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 414.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.94, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 222.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.55, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 296.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 29125 APPL SPLINT FOREARM", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 140.4, "maximum": 327.6, "gross_charge": 234.0, "discounted_cash": 175.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 327.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.54, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 280.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 175.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.31, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 234.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 29130 APPL SPLINT FINGER", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 137.4, "maximum": 320.6, "gross_charge": 229.0, "discounted_cash": 171.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 320.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.96, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 171.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.5, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 229.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 29260 STRAPPING OF ELBOWWRIST", "code_information": [ { "code": "29260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.4, "maximum": 159.6, "gross_charge": 114.0, "discounted_cash": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 85.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 29505 APPL SPLINT LONG LEG", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 118.2, "maximum": 275.8, "gross_charge": 197.0, "discounted_cash": 147.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 275.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.05, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 147.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 29515 APPL SPLINT SHORT LEG", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 417.0, "maximum": 973.0, "gross_charge": 695.0, "discounted_cash": 521.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 417.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 695.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 695.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 973.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 625.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 625.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 625.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 695.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 556.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 695.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 625.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 695.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 497.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 695.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 834.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 695.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 556.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 521.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 529.59, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 695.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 29540 STRAPPING ANKLE & OR FOOT", "code_information": [ { "code": "29540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 237.6, "maximum": 554.4, "gross_charge": 396.0, "discounted_cash": 297.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 396.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 396.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 554.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 396.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 396.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 396.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.54, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 396.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 475.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 396.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 301.75, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 396.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 29580 STRAPPING UNNA BOOT", "code_information": [ { "code": "29580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 237.6, "maximum": 554.4, "gross_charge": 396.0, "discounted_cash": 297.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 396.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 396.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 554.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 396.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 396.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.4, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 396.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.54, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 396.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 475.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 396.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 297.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 301.75, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 396.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 30300 REMV FB NOSE", "code_information": [ { "code": "30300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 131.4, "maximum": 306.6, "gross_charge": 219.0, "discounted_cash": 164.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 306.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.8, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 262.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 164.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.88, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 30901 CONTROL NOSEBLEED ANT SMPL", "code_information": [ { "code": "30901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 131.4, "maximum": 306.6, "gross_charge": 219.0, "discounted_cash": 164.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 306.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.8, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 262.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 164.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.88, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 219.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 31500 INTUBATE ENDOTRACEAL", "code_information": [ { "code": "31500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 247.2, "maximum": 576.8, "gross_charge": 412.0, "discounted_cash": 309.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 412.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 412.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 576.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 412.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 329.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 412.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 412.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 294.99, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 412.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 412.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 329.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 309.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.94, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 412.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 32551 TUBE THORACOSTOMY", "code_information": [ { "code": "32551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1601.4, "maximum": 3736.6, "gross_charge": 2669.0, "discounted_cash": 2001.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1601.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2669.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2669.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3736.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2402.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2402.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2402.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2669.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2135.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2669.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2402.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2669.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1911.0, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2669.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3202.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2669.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2135.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 2001.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2033.78, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2669.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 36556 INST NON-TNNL CV CTH>5 YRS", "code_information": [ { "code": "36556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3911.4, "maximum": 9126.6, "gross_charge": 6519.0, "discounted_cash": 4889.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3911.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 6519.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 6519.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 9126.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5867.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5867.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 5867.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 6519.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5215.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 6519.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5867.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 6519.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 4667.6, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 6519.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 7822.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 6519.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 5215.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 4889.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4967.48, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 6519.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 36680 INSERT NEEDLE BONE CAVITY INFUSION", "code_information": [ { "code": "36680", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 360.6, "maximum": 841.4, "gross_charge": 601.0, "discounted_cash": 450.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 601.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 601.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 841.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 540.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 540.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 540.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 601.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 480.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 601.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 540.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 601.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.32, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 601.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 721.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 601.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 480.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 450.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 457.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 601.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 41250 RPR LAC MOUTH <2.5CM ANT TONGUE", "code_information": [ { "code": "41250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 350.4, "maximum": 817.6, "gross_charge": 584.0, "discounted_cash": 438.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 584.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 584.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 817.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 584.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 467.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 584.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 584.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.14, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 584.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 700.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 584.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 467.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 438.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 445.01, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 584.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 43753 GASTRIC INTUBATION", "code_information": [ { "code": "43753", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 343.2, "maximum": 800.8, "gross_charge": 572.0, "discounted_cash": 429.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 343.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 572.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 572.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 800.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 572.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 457.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 572.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 572.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.55, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 572.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 686.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 572.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 457.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 429.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 435.86, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 572.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 51701 INSERT NON-INDWELLING BLADDER CATH", "code_information": [ { "code": "51701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 136.8, "maximum": 319.2, "gross_charge": 228.0, "discounted_cash": 171.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 319.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.25, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 171.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.74, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 51702 INSERT BLADDER CATH TEMP SMPL", "code_information": [ { "code": "51702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 136.8, "maximum": 319.2, "gross_charge": 228.0, "discounted_cash": 171.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 319.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.25, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 171.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.74, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 228.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 59409 ED DELIVERY VAGINAL ONLY", "code_information": [ { "code": "59409", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3216.6, "maximum": 7505.4, "gross_charge": 5361.0, "discounted_cash": 4020.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3216.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 5361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 5361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 7505.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4824.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4824.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 4824.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 5361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 5361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4824.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 5361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 3838.48, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 5361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 6433.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 5361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4288.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 4020.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4085.08, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 5361.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 64450 INJ NERVE BLOCK OTH PRPHRL", "code_information": [ { "code": "64450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 912.0, "maximum": 2128.0, "gross_charge": 1520.0, "discounted_cash": 1140.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 912.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1520.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1520.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2128.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1368.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1368.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1368.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1520.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1216.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1520.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1368.0, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1520.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1088.32, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1520.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1824.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1520.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1216.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1140.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1158.24, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1520.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 65205 REMV FB EYE CONJ SUPERFCL", "code_information": [ { "code": "65205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 166.2, "maximum": 387.8, "gross_charge": 277.0, "discounted_cash": 207.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 387.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.33, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 332.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 207.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.07, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 277.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 65220 REMV FB EYE CORNEAL WO SL", "code_information": [ { "code": "65220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 541.8, "maximum": 1264.2, "gross_charge": 903.0, "discounted_cash": 677.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 541.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 903.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 903.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1264.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 812.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 812.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 812.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 903.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 722.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 903.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 812.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 903.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 646.55, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 903.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1083.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 903.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 722.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 677.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 688.09, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 903.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 65235 REMV FB EYE INTRAOCULAR", "code_information": [ { "code": "65235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3077.4, "maximum": 7180.6, "gross_charge": 5129.0, "discounted_cash": 3846.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3077.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 5129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 5129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 7180.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4616.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4616.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 4616.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 5129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4103.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 5129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4616.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 5129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 3672.36, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 5129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 6154.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 5129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4103.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 3846.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3908.3, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 5129.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 67930 SUTURE EYELID WND PARTIAL", "code_information": [ { "code": "67930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2962.8, "maximum": 6913.2, "gross_charge": 4938.0, "discounted_cash": 3703.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2962.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 4938.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 4938.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 6913.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4444.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4444.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 4444.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 4938.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3950.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 4938.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 4444.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 4938.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 3535.61, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 4938.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 5925.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 4938.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3950.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 3703.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 3762.76, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 4938.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 69200 REMV FB OUTER EAR WO ANES", "code_information": [ { "code": "69200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 166.8, "maximum": 389.2, "gross_charge": 278.0, "discounted_cash": 208.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 278.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 278.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 389.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 278.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 222.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 278.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 278.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 199.05, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 278.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 333.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 278.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 222.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 208.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.84, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 278.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 69210 REMV IMPACTED EAR WAX INSTRUMENT UNI", "code_information": [ { "code": "69210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 91.2, "maximum": 212.8, "gross_charge": 152.0, "discounted_cash": 114.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 212.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.83, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 92950 CARDIOPULMON RESUSCITATION", "code_information": [ { "code": "92950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 871.8, "maximum": 2034.2, "gross_charge": 1453.0, "discounted_cash": 1089.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 871.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1453.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1453.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2034.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1307.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1307.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1307.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1453.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1162.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1453.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1307.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1453.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1040.35, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1453.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1743.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1453.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1162.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1089.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1107.19, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1453.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 92960 CARDIOVERSION", "code_information": [ { "code": "92960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 422.4, "maximum": 985.6, "gross_charge": 704.0, "discounted_cash": 528.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 422.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 704.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 704.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 985.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 633.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 633.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 633.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 704.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 563.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 704.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 633.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 704.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.06, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 704.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 844.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 704.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 563.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 528.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 536.45, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 704.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 94640 NON OR PRES'D INHALATION TX", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 48.6, "maximum": 113.4, "gross_charge": 81.0, "discounted_cash": 60.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 113.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.0, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 60.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 96360 IV INFUS THERAPY HYDRATION FLUIDS INITIAL 31 MIN-1HR", "code_information": [ { "code": "96360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 298.2, "maximum": 695.8, "gross_charge": 497.0, "discounted_cash": 372.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 298.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 695.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 447.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 447.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 447.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 447.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.85, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 596.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 372.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.71, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 96361 IV INFUS THERAPY HYDRATION FLUIDS ADDL HR", "code_information": [ { "code": "96361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 58.2, "maximum": 135.8, "gross_charge": 97.0, "discounted_cash": 72.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 135.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.45, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 72.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.91, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 96365 IV INFUS THER PROPH DIAG INITIAL UP TO 1HR", "code_information": [ { "code": "96365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 298.2, "maximum": 695.8, "gross_charge": 497.0, "discounted_cash": 372.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 298.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 695.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 447.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 447.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 447.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 447.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.85, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 596.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 372.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.71, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 96366 IV INFUS THER PROPH DIAG EA ADDL HR", "code_information": [ { "code": "96366", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 58.2, "maximum": 135.8, "gross_charge": 97.0, "discounted_cash": 72.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 135.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.45, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 72.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.91, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 96367 IV INFUS THER PROPH DIAG ADDL SEQ NEW DRUG UP TO 1 HR", "code_information": [ { "code": "96367", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 91.2, "maximum": 212.8, "gross_charge": 152.0, "discounted_cash": 114.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 212.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.83, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 96368 IV INFUS FOR THER PROPH DIAG CONCUR", "code_information": [ { "code": "96368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 35.4, "maximum": 82.6, "gross_charge": 59.0, "discounted_cash": 44.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 82.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.24, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 44.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 96372 THER PROPH DIAG INJECTION SQ IM", "code_information": [ { "code": "96372", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 91.2, "maximum": 212.8, "gross_charge": 152.0, "discounted_cash": 114.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 212.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.83, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.82, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 152.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 96374 THER PROPH DIAG INJ IV PUSH INITIAL", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 298.2, "maximum": 695.8, "gross_charge": 497.0, "discounted_cash": 372.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 298.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 695.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 447.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 447.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 447.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 447.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.85, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 596.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 372.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.71, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 497.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 96375 THER PROPH DIAG INJ IV PUSH ADDL SEQ", "code_information": [ { "code": "96375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 58.2, "maximum": 135.8, "gross_charge": 97.0, "discounted_cash": 72.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 135.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.45, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 72.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.91, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 97.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 96376 THER PROPH DIAG INJ IV PUSH SAME DRUG >30MINS", "code_information": [ { "code": "96376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 35.4, "maximum": 82.6, "gross_charge": 59.0, "discounted_cash": 44.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 82.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.24, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 44.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 59.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 99281 EMER CASE LEVEL I", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 158.49, "maximum": 369.81, "gross_charge": 264.15, "discounted_cash": 198.11, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.49, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 264.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 264.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 369.81, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.73, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.73, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.73, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 264.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.32, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 264.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.73, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 264.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.13, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 264.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.98, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 264.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.32, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 198.11, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.28, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 264.15, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 99282 EMER CASE LEVEL II", "code_information": [ { "code": "99282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 285.05, "maximum": 665.11, "gross_charge": 475.08000000000004, "discounted_cash": 356.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.05, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 475.08, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 475.08000000000004, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 665.11, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 427.57, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 427.57, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 427.57, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 475.08000000000004, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.06, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 475.08000000000004, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 427.57, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 475.08000000000004, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.16, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 475.08000000000004, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 570.1, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 475.08000000000004, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.06, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 356.31, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 362.01, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 475.08000000000004, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 99283 EMER CASE LEVEL III", "code_information": [ { "code": "99283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 498.4, "maximum": 1162.94, "gross_charge": 830.67, "discounted_cash": 623.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 498.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 830.67, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 830.67, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1162.94, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 747.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 747.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 747.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 830.67, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 664.54, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 830.67, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 747.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 830.67, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 594.76, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 830.67, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 996.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 830.67, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 664.54, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 623.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 632.97, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 830.67, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 99284 EMER CASE LEVEL IV", "code_information": [ { "code": "99284", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 766.48, "maximum": 1788.44, "gross_charge": 1277.46, "discounted_cash": 958.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 766.48, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1277.46, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1277.46, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1788.44, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1149.71, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1149.71, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1149.71, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1277.46, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1021.97, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1277.46, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1149.71, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1277.46, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 914.66, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1277.46, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1532.95, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1277.46, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1021.97, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 958.1, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 973.42, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1277.46, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 99285 EMER CASE LEVEL V", "code_information": [ { "code": "99285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1103.58, "maximum": 2575.02, "gross_charge": 1839.3000000000002, "discounted_cash": 1379.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1103.58, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1839.3, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1839.3000000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2575.02, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1655.37, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1655.37, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1655.37, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1839.3000000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1471.44, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1839.3000000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1655.37, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1839.3000000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1316.94, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1839.3000000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2207.16, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1839.3000000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1471.44, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1379.48, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1401.55, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1839.3000000000002, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 99291 CRITICAL CARE E&M 30-74 MIN", "code_information": [ { "code": "99291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1516.7, "maximum": 3538.96, "gross_charge": 2527.83, "discounted_cash": 1895.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1516.7, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 2527.83, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 2527.83, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 3538.96, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2275.05, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2275.05, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 2275.05, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2527.83, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2022.26, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2527.83, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2275.05, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 2527.83, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1809.93, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2527.83, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 3033.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 2527.83, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 2022.26, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1895.87, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1926.21, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 2527.83, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ED 99292 CRIT CARE EA ADDL 30 MINS", "code_information": [ { "code": "99292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 277.8, "maximum": 648.2, "gross_charge": 463.0, "discounted_cash": 347.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 463.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 463.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 648.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 416.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 416.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 416.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 463.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 463.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 416.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 463.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.51, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 463.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 555.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 463.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 347.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.81, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 463.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "NEB RX PFT", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 48.6, "maximum": 113.4, "gross_charge": 81.0, "discounted_cash": 60.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 113.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.0, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 60.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.72, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 81.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "TRAUMA ACTIVATION FULL W CCARE", "code_information": [ { "code": "G0390", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 417.0, "maximum": 973.0, "gross_charge": 695.0, "discounted_cash": 521.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 417.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 695.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 695.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 973.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 625.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 625.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 625.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 695.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 556.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 695.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 625.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 695.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 497.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 695.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 834.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 695.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 556.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 521.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 529.59, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 695.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "GROUND AMBULANCE PER MILE", "code_information": [ { "code": "A0425", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.8, "maximum": 53.2, "gross_charge": 38.0, "discounted_cash": 28.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 53.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.21, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 28.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.96, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 38.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "AMBULANCE ALS NON-EMERG LVL 1", "code_information": [ { "code": "A0426", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 718.2, "maximum": 1675.8, "gross_charge": 1197.0, "discounted_cash": 897.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 718.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1675.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1077.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1077.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1077.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 957.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1077.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 857.05, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 957.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 897.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 912.11, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1197.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "AMBULANCE ALS EMERGENCY LVL 1", "code_information": [ { "code": "A0427", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1135.8, "maximum": 2650.2, "gross_charge": 1893.0, "discounted_cash": 1419.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1135.8, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1893.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1893.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2650.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1703.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1703.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1703.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1893.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1514.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1893.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1703.7, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1893.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1355.39, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1893.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 2271.6, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1893.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1514.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1419.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1442.47, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1893.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "AMBULANCE BLS NON-EMERG", "code_information": [ { "code": "A0428", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 598.2, "maximum": 1395.8, "gross_charge": 997.0, "discounted_cash": 747.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 598.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 997.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 997.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 1395.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 897.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 897.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 897.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 997.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 797.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 997.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 897.3, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 997.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 713.85, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 997.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1196.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 997.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 797.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 747.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 759.71, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 997.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "AMBULANCE BLS EMERGENCY", "code_information": [ { "code": "A0429", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 957.0, "maximum": 2233.0, "gross_charge": 1595.0, "discounted_cash": 1196.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 957.0, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 1595.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 1595.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 2233.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1435.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1435.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 1435.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1595.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1276.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1595.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1435.5, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 1595.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 1142.02, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1595.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 1914.0, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 1595.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1276.0, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 1196.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 1215.39, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 1595.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "ECG TRACING WO INTERP", "code_information": [ { "code": "93005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 44.55, "maximum": 103.95, "gross_charge": 74.25, "discounted_cash": 55.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.55, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 74.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 74.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 103.95, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.83, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.83, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.83, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 74.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 74.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.83, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 74.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.16, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 74.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.1, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 74.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 55.69, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.58, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 74.25, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "HOLTER MONITOR APP UP TO 48 HOURS", "code_information": [ { "code": "93225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.4, "maximum": 159.6, "gross_charge": 114.0, "discounted_cash": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.6, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.62, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.8, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.2, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 85.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.87, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 114.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "EXTERNAL ECG REC > 48HR < 7D RECORDING", "code_information": [ { "code": "93242", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 25.2, "maximum": 58.8, "gross_charge": 42.0, "discounted_cash": 31.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 58.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.07, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 31.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.0, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "EXTERNAL ECG REC > 7D < 15D RECORDING", "code_information": [ { "code": "93246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 25.2, "maximum": 58.8, "gross_charge": 42.0, "discounted_cash": 31.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 58.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.07, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.4, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.6, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 31.5, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.0, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 42.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] }, { "description": "EVENT MONITOR RECORDING 30 DAY", "code_information": [ { "code": "93270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 24.6, "maximum": 57.4, "gross_charge": 41.0, "discounted_cash": 30.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "standard_charge_percentage": 0.6, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Aetna", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Lessor of charges or BCBS Fee Schedule", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota BCBS Medicaid Expansion", "plan_name": "Medicaid Expansion", "methodology": "fee schedule", "standard_charge_dollar": 57.4, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Cigna", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Healthpartners Medicare Advantage", "plan_name": "Medicare Replacement", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Humana Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Medica Medicare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Commercial", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "standard_charge_percentage": 0.9, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Multiplan Medicare", "plan_name": "Medicare Replacement", "methodology": "other", "standard_charge_algorithm": "Medicare allowable", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "North Dakota Medicaid", "plan_name": "Medicaid", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.36, "standard_charge_percentage": 0.716, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "NextBlue", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Noridian Medicare", "plan_name": "Medicare", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "standard_charge_percentage": 1.2, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "Sanford Health Plan", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Percent of CMS Fee Schedule", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TLC Advantage", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.8, "standard_charge_percentage": 0.8, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "TriCare", "plan_name": "VA", "methodology": "other", "standard_charge_dollar": 30.75, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.24, "standard_charge_percentage": 0.762, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." }, { "payer_name": "United Healthcare", "plan_name": "Medicare Replacement", "methodology": "fee schedule", "standard_charge_algorithm": "CMS Interim Rate for facility", "standard_charge_dollar": 41.0, "count": "0", "additional_payer_notes": "No EDI 835 remittance data available for the 12-15 month period. Count = 0, percentile amounts not applicable." } ] } ] } ] }