{ "hospital_name": "Mt. Grant General Hospital", "last_updated_on": "2025-09-10", "version": "2.0.0", "hospital_location": [ "Mt Grant General Hospital" ], "hospital_address": [ "200 S. A St., Hawthorne, NV 89415" ], "license_information": { "state": "NV", "license_number": "RVH-651" }, "affirmation": { "confirm_affirmation": true, "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." }, "hospital_financial_aid_policy": "https://mgghnv.org/no-surprises-act/", "standard_charge_information": [ { "description": "HH ADSD HOMEMAKER 0.25 HOURS", "code_information": [ { "code": "0551", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 3.75, "minimum": 3.75 } ] }, { "description": "HH ADSD HOMEMAKER 0.5 HOURS", "code_information": [ { "code": "0551", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 7.5, "minimum": 7.5 } ] }, { "description": "HH CHIPS HOMEMAKER 0.25 HOURS", "code_information": [ { "code": "0551", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 3.75, "minimum": 3.75 } ] }, { "description": "HH ADSD HOMEMAKER 1 HOUR", "code_information": [ { "code": "0551", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 15, "minimum": 15 } ] }, { "description": "HH CHIPS HOMEMAKER 0.5 HOURS", "code_information": [ { "code": "0551", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 7.5, "minimum": 7.5 } ] }, { "description": "HH ADSD ATTENDANT 0.25 HOURS", "code_information": [ { "code": "0551", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 4.25, "minimum": 4.25 } ] }, { "description": "HH CHIPS HOMEMAKER 1 HOUR", "code_information": [ { "code": "0551", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 15, "minimum": 15 } ] }, { "description": "HH ADSD ATTENDANT 0.5 HOURS", "code_information": [ { "code": "0551", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 8.5, "minimum": 8.5 } ] }, { "description": "HH CHIPS ATTENDANT 0.25 HOURS", "code_information": [ { "code": "0551", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 4.25, "minimum": 4.25 } ] }, { "description": "HH ADSD ATTENDANT 1 HOUR", "code_information": [ { "code": "0551", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 17, "minimum": 17 } ] }, { "description": "HH CHIPS ATTENDANT 0.5 HOURS", "code_information": [ { "code": "0551", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 8.5, "minimum": 8.5 } ] }, { "description": "HH CHIPS ATTENDANT 1 HOUR", "code_information": [ { "code": "0551", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 17, "minimum": 17 } ] }, { "description": "RUBELLA ANTIBODIES (IGG, IGM)", "code_information": [ { "code": "86762", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "LACTATE DEHYDROGENASE (LD) ISOENZYME PANEL", "code_information": [ { "code": "0301", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "MICROALBUMIN, RANDOM URINE WITH CREATININE (6517)", "code_information": [ { "code": "0301", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "ALPHA-THALASSEMIA DNA MUTATION ANALYSIS", "code_information": [ { "code": "0301", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "MISCELLANEOUS SENDOUT TEST", "code_information": [ { "code": "0301", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "ANCA VASCULITIDES", "code_information": [ { "code": "0301", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "TESTOSTERONE, FREE, BIOAVAILABLE AND TOTAL, LC/MS/MS", "code_information": [ { "code": "0301", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "17-KETOSTEROIDS W/CREAT, 24-HR URINE", "code_information": [ { "code": "0301", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "5-HYDROXYINDOLEACETIC ACID (5-HIAA), 24-HR URINE W/CREAT", "code_information": [ { "code": "0301", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "5-HYDROXYINDOLEACETIC ACID (5-HIAA), RANDOM URINE", "code_information": [ { "code": "0301", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "THYROID PANEL", "code_information": [ { "code": "0300", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "NO CHARGE", "code_information": [ { "code": "0250", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "CLOTRIMAZOLE 10 MG TROCHE", "drug_information": { "unit": "10", "type": "GR" }, "code_information": [ { "code": "00054414622", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "WATER FOR INJECTION, STERILE INJECTION SOLUTION", "code_information": [ { "code": "0250", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "SULFASALAZINE 500 MG TABLET", "drug_information": { "unit": "500", "type": "UN" }, "code_information": [ { "code": "00591079601", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "BICALUTAMIDE 50 MG TABLET", "drug_information": { "unit": "50", "type": "UN" }, "code_information": [ { "code": "41616048583", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "HH IIIB HOMEMAKER 0.25 HOURS", "code_information": [ { "code": "99600,LO", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 4.42, "minimum": 4.42 } ] }, { "description": "HH IIIB HOMEMAKER 0.5 HOURS", "code_information": [ { "code": "99600,ME", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 8.84, "minimum": 8.84 } ] }, { "description": "HH IIIB HOMEMAKER 1 HOUR", "code_information": [ { "code": "99600,HI", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 17.68, "minimum": 17.68 } ] }, { "description": "NO CHARGE VISIT", "code_information": [ { "code": "0526", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "NURSE-ONLY VISIT, NO CHG", "code_information": [ { "code": "99211,NC", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "POSTOPERATIVE FOLLOW-UP VISIT, INCLUDED IN SURGICAL PACKAGE", "code_information": [ { "code": "99024", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "CARRY GOAL STATUS", "code_information": [ { "code": "G8985", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 0.01, "minimum": 0.01 } ] }, { "description": "SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK", "drug_information": { "unit": "100", "type": "ML" }, "code_information": [ { "code": "00338055318", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "VITAMIN E 200 UNIT CAPSULE", "drug_information": { "unit": "200", "type": "UN" }, "code_information": [ { "code": "00904027260", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "NO SHOW FEE", "code_information": [ { "code": "0521", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 25, "minimum": 25 } ] }, { "description": "SUPPLIES", "code_information": [ { "code": "0250", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 2, "minimum": 2 } ] }, { "description": "JAK2 EXONS 12 AND 13 MUTATIONS, QUALITATIVE, LEUMETA", "code_information": [ { "code": "81403", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "LIVER FIBROSIS PANEL", "code_information": [ { "code": "81596", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 409, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 409, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 409, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 400, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 375, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 151, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 151, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 151, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 151, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 151, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 430, "minimum": 430 } ] }, { "description": "PEDIATRIC ROOM", "code_information": [ { "code": "0123", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1618, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1618, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1618, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1584, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1483, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 596, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 596, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 596, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 596, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 596, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1703, "minimum": 1703 } ] }, { "description": "RECOVERY ROOM", "code_information": [ { "code": "0710", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 247, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 247, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 247, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 242, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 226, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 260, "minimum": 260 } ] }, { "description": "RECOVERY ROOM/HR (\u003e 1 HR)", "code_information": [ { "code": "0710", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 496, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 496, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 496, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 485, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 455, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 183, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 183, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 183, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 183, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 183, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 522, "minimum": 522 } ] }, { "description": "YAG LASER", "code_information": [ { "code": "66821,RT", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 742, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 742, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 742, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 726, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 680, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 273, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 273, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 273, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 273, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 273, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 781, "minimum": 781 } ] }, { "description": "YAG LASER LT", "code_information": [ { "code": "66821,LT", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 742, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 742, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 742, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 726, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 680, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 273, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 273, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 273, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 273, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 273, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 781, "minimum": 781 } ] }, { "description": "CASTING ROLL FIBERGLASS", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 13, "minimum": 13 } ] }, { "description": "FLEX A FLOW FEED TUBE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 74, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 74, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 74, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 73, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 68, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 78, "minimum": 78 } ] }, { "description": "URINARY LEG BAG", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 21, "minimum": 21 } ] }, { "description": "COBAN 3 IN", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 13, "minimum": 13 } ] }, { "description": "ELASTAPLAST", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 15, "minimum": 15 } ] }, { "description": "COBAN 6 IN", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 21, "minimum": 21 } ] }, { "description": "BANDAGE CONFORM GAUZE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 12, "minimum": 12 } ] }, { "description": "BANDAGE ACE WRAP", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 21, "minimum": 21 } ] }, { "description": "EXTERNAL PACING", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 376, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 376, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 376, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 368, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 345, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 139, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 139, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 139, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 139, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 139, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 396, "minimum": 396 } ] }, { "description": "GELOCAST UNNA BOOT", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 60, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 60, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 60, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 59, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 63, "minimum": 63 } ] }, { "description": "COBAN STERILE 6 IN", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 35, "minimum": 35 } ] }, { "description": "FEMALE MINI CATH KIT", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 41, "minimum": 41 } ] }, { "description": "CATHETER MALE TEXAS", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 35, "minimum": 35 } ] }, { "description": "CATHETER FOLEY TUBE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 44, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 44, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 44, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 43, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 46, "minimum": 46 } ] }, { "description": "CATHETER SUBCLAVIAN", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 63, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 63, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 63, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 66, "minimum": 66 } ] }, { "description": "SUCTION TIP CATHETER 18FR", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 38, "minimum": 38 } ] }, { "description": "CATHETER SUPRAPUBIC", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 217, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 217, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 217, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 212, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 199, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 228, "minimum": 228 } ] }, { "description": "CATHETER UMBILICAL VESSEL", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 75, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 75, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 75, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 73, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 79, "minimum": 79 } ] }, { "description": "URINARY DRAINAGE BAG", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 89, "minimum": 89 } ] }, { "description": "JACKSON PRATT DRAIN OR", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 75, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 75, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 75, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 73, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 79, "minimum": 79 } ] }, { "description": "JACKSON PRATT RESERVOIR", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 60, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 60, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 60, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 59, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 63, "minimum": 63 } ] }, { "description": "PENROSE DRAIN", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 41, "minimum": 41 } ] }, { "description": "DRSG COMBINE ABD 8X10", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 24, "minimum": 24 } ] }, { "description": "DUODERM 4X4", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 25, "minimum": 25 } ] }, { "description": "DUODERM 8X8", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 29, "minimum": 29 } ] }, { "description": "BANDAGE GAUZE BULKY", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 15, "minimum": 15 } ] }, { "description": "DRSG NONADHERING", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 12, "minimum": 12 } ] }, { "description": "DRSG TRANSPARENT", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 11, "minimum": 11 } ] }, { "description": "DRSG, INTRASITE GEL", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 19, "minimum": 19 } ] }, { "description": "PACKING OXCEL 2IN BOTTLE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 37, "minimum": 37 } ] }, { "description": "DRSG, ADHESIVE SURG 8X6", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 12, "minimum": 12 } ] }, { "description": "DRSG VASELINE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 13, "minimum": 13 } ] }, { "description": "VENA GUARD", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 15, "minimum": 15 } ] }, { "description": "DRSG XEROFORM", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 18, "minimum": 18 } ] }, { "description": "CURAD ENEMA 19 GRAM-7 GRAM/118 ML", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 24, "minimum": 24 } ] }, { "description": "SOAP SUDS ENEMA", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 37, "minimum": 37 } ] }, { "description": "K-PAD DISPOSABLE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 37, "minimum": 37 } ] }, { "description": "PLEURAVAC", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 828, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 828, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 828, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 811, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 760, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 305, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 305, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 305, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 305, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 305, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 872, "minimum": 872 } ] }, { "description": "AQUACEL DRESS", "code_information": [ { "code": "A6223", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 375, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 375, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 375, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 367, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 344, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 138, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 138, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 138, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 138, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 138, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 395, "minimum": 395 } ] }, { "description": "PACKING VASELINE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 15, "minimum": 15 } ] }, { "description": "DRSG XEROFORM", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 18, "minimum": 18 } ] }, { "description": "PACKING NUGAUZE IODOFORM", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 25, "minimum": 25 } ] }, { "description": "PACKING NUGAUZE PLAIN", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 21, "minimum": 21 } ] }, { "description": "MITEK MINI ANCHOR", "code_information": [ { "code": "99070", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 399, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 399, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 399, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 391, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 366, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 147, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 147, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 147, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 147, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 147, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 420, "minimum": 420 } ] }, { "description": "HEPARIN LOCK", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 34, "minimum": 34 } ] }, { "description": "EPISTAXI PACKING", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 75, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 81, "minimum": 81 } ] }, { "description": "ELBOW TURN BUCKLE ORTHOSI", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 313, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 313, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 313, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 306, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 287, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 115, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 115, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 115, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 115, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 115, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 329, "minimum": 329 } ] }, { "description": "IV CATHETER", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 34, "minimum": 34 } ] }, { "description": "SPLINT, FINGER W/CLOSURE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 40, "minimum": 40 } ] }, { "description": "SPLINT, ANKLE AIR STIRUP", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 127, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 119, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 137, "minimum": 137 } ] }, { "description": "SPLINT, ARM IMMOBILIZER", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 84, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 84, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 84, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 82, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 88, "minimum": 88 } ] }, { "description": "INTRAOSSEOUS NEEDLE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 394, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 394, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 394, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 386, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 361, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 145, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 145, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 145, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 145, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 145, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 415, "minimum": 415 } ] }, { "description": "RIB BELT WOMAN", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 60, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 65, "minimum": 65 } ] }, { "description": "RIB BELT MEN", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 60, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 65, "minimum": 65 } ] }, { "description": "FOAM WALKER BOOT", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 226, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 226, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 226, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 221, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 207, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 238, "minimum": 238 } ] }, { "description": "SPLINT, ANKLE CANVAS BRAC", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 86, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 86, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 86, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 84, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 90, "minimum": 90 } ] }, { "description": "SPLINT, BACK BRACE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 111, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 111, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 111, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 109, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 102, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 117, "minimum": 117 } ] }, { "description": "CAST ARM FULL", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 195, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 195, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 195, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 191, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 179, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 72, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 72, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 72, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 72, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 72, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 205, "minimum": 205 } ] }, { "description": "CAST HAND", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 96, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 90, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 103, "minimum": 103 } ] }, { "description": "CAST FOREARM", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 114, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 114, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 114, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 112, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 120, "minimum": 120 } ] }, { "description": "CAST LEG FULL", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 211, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 211, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 211, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 206, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 193, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 222, "minimum": 222 } ] }, { "description": "CAST LEG HALF", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 127, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 119, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 137, "minimum": 137 } ] }, { "description": "CAST POSTERIOR ARM", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 96, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 90, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 103, "minimum": 103 } ] }, { "description": "CAST POSTERIOR LEG", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 96, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 90, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 103, "minimum": 103 } ] }, { "description": "SPLINT, PLASTER", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 54, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 51, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 58, "minimum": 58 } ] }, { "description": "SPLINT, CLAVICLE BRACE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 84, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 84, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 84, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 82, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 88, "minimum": 88 } ] }, { "description": "CATHETER SELF TUBE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 11, "minimum": 11 } ] }, { "description": "CERVICAL COLLAR PHILADEL", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 113, "minimum": 113 } ] }, { "description": "CERVICAL STIFFNECK COLLAR", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 90, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 90, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 90, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 88, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 95, "minimum": 95 } ] }, { "description": "SPLINT, MULTI KNEE PANEL", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 167, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 167, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 167, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 164, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 153, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 176, "minimum": 176 } ] }, { "description": "SPLINT KNEE SUPPORT", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 155, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 155, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 155, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 152, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 142, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 163, "minimum": 163 } ] }, { "description": "CAST SHOE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 54, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 51, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 58, "minimum": 58 } ] }, { "description": "ARM SLING", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 38, "minimum": 38 } ] }, { "description": "POLYPECTOMY SNARE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 41, "minimum": 41 } ] }, { "description": "SPLINT, FINGER STRIP 2\"", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 11, "minimum": 11 } ] }, { "description": "SPLINT, BASEBALL", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 16, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 17, "minimum": 17 } ] }, { "description": "SPLINT,MASON ALLEN COCKUP", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 60, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 65, "minimum": 65 } ] }, { "description": "SPLINT,FOREARM PADDED", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 66, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 66, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 66, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 64, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 60, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 69, "minimum": 69 } ] }, { "description": "SPLINT THUMB SPICA", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 114, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 114, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 114, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 112, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 120, "minimum": 120 } ] }, { "description": "SPLINT, ELASTIC WRIST", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 28, "minimum": 28 } ] }, { "description": "SPLINT, FOAM WRIST", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 66, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 66, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 66, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 64, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 60, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 69, "minimum": 69 } ] }, { "description": "TENNIS ELBOW SUPPORT", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 16, "minimum": 16 } ] }, { "description": "INTRAOCULAR LENS", "code_information": [ { "code": "V2632", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 270, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 270, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 270, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 264, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 247, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 99, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 99, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 99, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 99, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 99, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 284, "minimum": 284 } ] }, { "description": "ALCON TORIC LENS", "code_information": [ { "code": "V2787", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 945, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 945, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 945, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 925, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 867, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 348, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 348, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 348, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 348, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 348, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 995, "minimum": 995 } ] }, { "description": "SOFTWICK DRAIN SPONGE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 9, "minimum": 9 } ] }, { "description": "DRSG, GAUZE STERILE 4X4", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 11, "minimum": 11 } ] }, { "description": "TED STOCKING ALL", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 60, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 56, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 64, "minimum": 64 } ] }, { "description": "ABDOMINAL BINDER", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 126, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 126, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 126, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 116, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 47, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 47, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 47, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 47, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 47, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 133, "minimum": 133 } ] }, { "description": "CATHETER LEG STRAP", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 35, "minimum": 35 } ] }, { "description": "SUCTION CANISTER", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 35, "minimum": 35 } ] }, { "description": "FEMALE MINI CATH KIT", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 54, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 51, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 58, "minimum": 58 } ] }, { "description": "PACKING SURGICEL", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 32, "minimum": 32 } ] }, { "description": "BILATERAL NASAL PAC", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 70, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 70, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 70, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 64, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 74, "minimum": 74 } ] }, { "description": "SUTURE EACH", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 25, "minimum": 25 } ] }, { "description": "STAPLE REMOVER", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 54, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 54, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 54, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 53, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 50, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 57, "minimum": 57 } ] }, { "description": "STAPLER 5 SHOT OR", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 54, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 54, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 54, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 53, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 50, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 57, "minimum": 57 } ] }, { "description": "BALLOON DILATOR", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 396, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 396, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 396, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 388, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 363, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 146, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 146, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 146, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 146, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 146, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 417, "minimum": 417 } ] }, { "description": "NASAL PAC", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 50, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 50, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 50, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 49, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 53, "minimum": 53 } ] }, { "description": "STERI STRIP PACK ONE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 11, "minimum": 11 } ] }, { "description": "INFLATION DILATION", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 29, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 29, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 29, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 29, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 29, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 82, "minimum": 82 } ] }, { "description": "COLONIC OVERTUBE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 331, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 331, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 331, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 324, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 303, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 348, "minimum": 348 } ] }, { "description": "MASTASOL 1 APPLICATION", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 7, "minimum": 7 } ] }, { "description": "TRAY FOLEY", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 89, "minimum": 89 } ] }, { "description": "HAND/WRIST/FINGR ORTHOSIS", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 266, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 266, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 266, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 260, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 244, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 280, "minimum": 280 } ] }, { "description": "TRAY IRRIGATION", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 44, "minimum": 44 } ] }, { "description": "BIOFLEX PLA PIN", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 498, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 498, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 498, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 487, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 456, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 183, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 183, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 183, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 183, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 183, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 524, "minimum": 524 } ] }, { "description": "SURGICAL STEEL SUTURE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 40, "minimum": 40 } ] }, { "description": "K-WIRE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 44, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 50, "minimum": 50 } ] }, { "description": "TRAY URETHRAL CATH", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 89, "minimum": 89 } ] }, { "description": "TRACHEOTOMY CARE KIT", "code_information": [ { "code": "A4629", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 13, "minimum": 13 } ] }, { "description": "TRIPLE LUMEN CATH KIT", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 102, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 102, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 102, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 100, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 93, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 107, "minimum": 107 } ] }, { "description": "IRRIGATION TUBE 4 LEAD", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 113, "minimum": 113 } ] }, { "description": "CATHETER,URETHRAL RED RUB", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 16, "minimum": 16 } ] }, { "description": "INTERJECT INJECTION NEEDL", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 86, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 92, "minimum": 92 } ] }, { "description": "FEEDING TUBE ALL SIZE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 41, "minimum": 41 } ] }, { "description": "OSTMY SKIN BARR FILM EACH", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 4, "minimum": 4 } ] }, { "description": "HEASINE PASTE 1OZ", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 12, "minimum": 12 } ] }, { "description": "LEG BAG ADAPTER \u0026 TUBE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 28, "minimum": 28 } ] }, { "description": "SALEM SUMP", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 25, "minimum": 25 } ] }, { "description": "PUPIL DILATOR", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 110, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 110, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 110, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 108, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 101, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 116, "minimum": 116 } ] }, { "description": "URIMETER DRAIN BAG", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 95, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 95, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 95, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 93, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 100, "minimum": 100 } ] }, { "description": "COLOSTOMY WAFER EA", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 12, "minimum": 12 } ] }, { "description": "COLOSTOMY BAGS EA", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 7, "minimum": 7 } ] }, { "description": "RESOLUTION CLIP", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 352, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 352, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 352, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 345, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 323, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 371, "minimum": 371 } ] }, { "description": "PROMOGRAN DRESSING", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 26, "minimum": 26 } ] }, { "description": "COLLAGEN MATRIX 5CM X 2CM", "code_information": [ { "code": "A6024", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1157, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1157, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1157, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1133, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1061, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 426, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 426, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 426, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 426, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 426, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1218, "minimum": 1218 } ] }, { "description": "CALCIUM ALGINATE DRESSING 2X2", "code_information": [ { "code": "A6196", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 6, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 2, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 6, "minimum": 6 } ] }, { "description": "ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND, FILLER, STERILE, PER 6 IN", "code_information": [ { "code": "A6199", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 27, "minimum": 27 } ] }, { "description": "ROTH NET STANDARD", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 165, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 165, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 165, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 162, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 152, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 174, "minimum": 174 } ] }, { "description": "POLY TRAP", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 28, "minimum": 28 } ] }, { "description": "VAC GRANUFOAM SM DRSG", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 60, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 56, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 64, "minimum": 64 } ] }, { "description": "ATS CANISTER", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 44, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 50, "minimum": 50 } ] }, { "description": "ROTH NET, FOOD BOLUS RTRV", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 165, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 165, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 165, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 162, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 152, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 174, "minimum": 174 } ] }, { "description": "6 SHOT MULTI BAND LIGATOR", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 583, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 583, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 583, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 571, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 535, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 614, "minimum": 614 } ] }, { "description": "SPRAY CATHETER", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 165, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 165, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 165, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 162, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 152, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 61, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 174, "minimum": 174 } ] }, { "description": "ALLEVYN CLASSIC WOUND DRSG 3\" x 3\"", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 14, "minimum": 14 } ] }, { "description": "ALLEVYN CLASSIC WOUND DRSG 5\" x 5\"", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 21, "minimum": 21 } ] }, { "description": "RESTORE SILVER ALGINATE 4\" x 4.75\"", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 26, "minimum": 26 } ] }, { "description": "BALLOON 8, 9, 10 MM", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 550, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 550, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 550, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 538, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 504, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 203, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 203, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 203, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 203, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 203, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 579, "minimum": 579 } ] }, { "description": "DERMABOND, TUBE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 96, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 96, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 96, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 94, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 88, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 101, "minimum": 101 } ] }, { "description": "TRACHEOSTOMY TUBE DISPOSA", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 90, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 90, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 90, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 88, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 95, "minimum": 95 } ] }, { "description": "TRACHEAL INNER CANNULA", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 15, "minimum": 15 } ] }, { "description": "LIGATOR BAND, HEMORRHOID", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 237, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 237, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 237, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 232, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 217, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 249, "minimum": 249 } ] }, { "description": "ORTHOPEDIC SCREW", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 380, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 380, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 380, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 372, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 348, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 140, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 140, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 140, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 140, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 140, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 400, "minimum": 400 } ] }, { "description": "ESOPHAG COLON BALLOON DIL", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 605, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 605, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 605, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 592, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 555, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 223, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 223, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 223, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 223, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 223, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 637, "minimum": 637 } ] }, { "description": "OCULAR IMPLANT", "code_information": [ { "code": "L8610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 550, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 550, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 550, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 538, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 504, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 203, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 203, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 203, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 203, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 203, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 579, "minimum": 579 } ] }, { "description": "PEG TUBE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 418, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 418, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 418, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 409, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 383, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 154, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 154, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 154, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 154, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 154, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 440, "minimum": 440 } ] }, { "description": "VAC ATS THER UNIT PER DAY", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 119, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 111, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 128, "minimum": 128 } ] }, { "description": "REPLACEMENT PEG TUBE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 70, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 70, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 70, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 64, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 74, "minimum": 74 } ] }, { "description": "RHYTHM STRIP", "code_information": [ { "code": "93005", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 29, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 29, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 29, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 29, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 29, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 82, "minimum": 82 } ] }, { "description": "UPPER EXTREMITY LT WO/W CONTR", "code_information": [ { "code": "73202", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 2137, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 2137, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 2137, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 2092, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1959, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 787, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 787, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 787, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 787, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 787, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 2249, "minimum": 2249 } ] }, { "description": "ARTERIAL KIT", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 56, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 52, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 60, "minimum": 60 } ] }, { "description": "BAG AMBU DISPOSABLE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 206, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 206, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 206, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 202, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 189, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 217, "minimum": 217 } ] }, { "description": "CANNULA PEDIATRIC/INFANT", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 22, "minimum": 22 } ] }, { "description": "AIRWAY ORAL", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 23, "minimum": 23 } ] }, { "description": "EASY CAP", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 84, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 84, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 84, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 82, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 88, "minimum": 88 } ] }, { "description": "TUBE ENDO TRACHEAL", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 117, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 117, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 117, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 114, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 43, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 43, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 43, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 43, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 43, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 123, "minimum": 123 } ] }, { "description": "KING TUBE", "code_information": [ { "code": "0272", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 93, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 93, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 93, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 98, "minimum": 98 } ] }, { "description": "TUBE HOLDER ENDO TRACHEAL", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 43, "minimum": 43 } ] }, { "description": "HUMIDIFIER DISPOSABLE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 40, "minimum": 40 } ] }, { "description": "OXYGEN TUBING CONNECTOR", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 4, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 10, "minimum": 10 } ] }, { "description": "LUNG VOLUME EXERCISER", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 68, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 68, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 68, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 67, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 63, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 72, "minimum": 72 } ] }, { "description": "MASK AEROSOL", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 26, "minimum": 26 } ] }, { "description": "MASK HIGH CONCENTRATION", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 26, "minimum": 26 } ] }, { "description": "MASK NON-REBREATHING", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 28, "minimum": 28 } ] }, { "description": "MASK SIMPLE OXYGEN ADULT", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 26, "minimum": 26 } ] }, { "description": "MASK TRACHEAL", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 23, "minimum": 23 } ] }, { "description": "MASK VENTI", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 29, "minimum": 29 } ] }, { "description": "MDI SPACER W/WO MASK", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 50, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 50, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 50, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 49, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 53, "minimum": 53 } ] }, { "description": "MASK SIMPLE OXY, PED/INF", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 24, "minimum": 24 } ] }, { "description": "MIST TENT CANOPY", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 121, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 113, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 130, "minimum": 130 } ] }, { "description": "MIST TENT PER HR W/O O2", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 21, "minimum": 21 } ] }, { "description": "MIST TENT PER HR WITH O2", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 43, "minimum": 43 } ] }, { "description": "MUCUS DELEE TRAP", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 39, "minimum": 39 } ] }, { "description": "NASO/PHARY AIRWAY", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 97, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 97, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 97, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 95, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 89, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 102, "minimum": 102 } ] }, { "description": "NEBULIZER PACKAGE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 38, "minimum": 38 } ] }, { "description": "OXISENSOR", "code_information": [ { "code": "0410", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 114, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 131, "minimum": 131 } ] }, { "description": "OXYGEN CANNULA ADULT", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 23, "minimum": 23 } ] }, { "description": "TUBING OXYGEN 21 FEET", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 48, "minimum": 48 } ] }, { "description": "PEAK FLOW METER", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 84, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 84, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 84, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 82, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 88, "minimum": 88 } ] }, { "description": "TUBING LARGE BORE 3 FEET", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 24, "minimum": 24 } ] }, { "description": "WATER TRAP", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 23, "minimum": 23 } ] }, { "description": "FLUTTER VALVE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 84, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 84, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 84, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 82, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 88, "minimum": 88 } ] }, { "description": "Variable concentration mask", "code_information": [ { "code": "A4620", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 14, "minimum": 14 } ] }, { "description": "COMBITUBE", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 211, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 211, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 211, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 206, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 193, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 78, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 222, "minimum": 222 } ] }, { "description": "SMART VEST - VEST ONLY", "code_information": [ { "code": "0270", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 280, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 280, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 280, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 274, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 257, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 103, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 103, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 103, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 103, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 103, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 295, "minimum": 295 } ] }, { "description": "Phosphorus, 24-hr urine", "code_information": [ { "code": "84105", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 74, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 70, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 80, "minimum": 80 } ] }, { "description": "RENAL PANEL", "code_information": [ { "code": "80069", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 193, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 193, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 193, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 189, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 177, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 203, "minimum": 203 } ] }, { "description": "ETOH", "code_information": [ { "code": "80320", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 167, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 167, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 167, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 164, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 153, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 62, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 176, "minimum": 176 } ] }, { "description": "DIRECT COOMBS", "code_information": [ { "code": "0300", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 74, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 74, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 74, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 73, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 68, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 78, "minimum": 78 } ] }, { "description": "BLEEDING TIME", "code_information": [ { "code": "85002", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 113, "minimum": 113 } ] }, { "description": "CHLORIDE", "code_information": [ { "code": "82436", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 7, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 21, "minimum": 21 } ] }, { "description": "CARBON DIOXIDE", "code_information": [ { "code": "82374", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 48, "minimum": 48 } ] }, { "description": "GENERAL HEALTH PANEL", "code_information": [ { "code": "80050", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 356, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 356, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 356, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 349, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 327, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 131, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 131, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 131, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 131, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 131, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 375, "minimum": 375 } ] }, { "description": "LIVER PANEL", "code_information": [ { "code": "80076", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 126, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 126, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 126, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 116, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 47, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 47, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 47, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 47, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 47, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 133, "minimum": 133 } ] }, { "description": "DRUGS OF ABUSE SCREEN (DAU)", "code_information": [ { "code": "80305", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 242, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 242, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 242, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 237, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 222, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 89, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 89, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 89, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 89, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 89, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 255, "minimum": 255 } ] }, { "description": "ERRG - DRUGS OF ABUSE SCREEN (DAU)", "code_information": [ { "code": "80305", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 115, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 115, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 115, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 113, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 121, "minimum": 121 } ] }, { "description": "WHITE BLOOD COUNT", "code_information": [ { "code": "85048", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 39, "minimum": 39 } ] }, { "description": "RED BLOOD CELLS COUNT", "code_information": [ { "code": "85041", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 12, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 5, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 13, "minimum": 13 } ] }, { "description": "LITHIUM", "code_information": [ { "code": "80178", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 148, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 148, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 148, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 145, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 136, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 156, "minimum": 156 } ] }, { "description": "OCCULT BLOOD", "code_information": [ { "code": "82270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 110, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 110, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 110, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 108, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 101, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 116, "minimum": 116 } ] }, { "description": "IPPB TX INITIAL", "code_information": [ { "code": "94640", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 68, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 68, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 68, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 67, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 63, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 72, "minimum": 72 } ] }, { "description": "PEAK FLOW RATE", "code_information": [ { "code": "94060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 43, "minimum": 43 } ] }, { "description": "PROTIME W/INR", "code_information": [ { "code": "85610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 72, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 72, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 72, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 66, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 76, "minimum": 76 } ] }, { "description": "SODIUM", "code_information": [ { "code": "84295", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 48, "minimum": 48 } ] }, { "description": "HDL CHOLESTEROL", "code_information": [ { "code": "83718", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 74, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 74, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 74, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 73, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 68, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 78, "minimum": 78 } ] }, { "description": "BUN", "code_information": [ { "code": "84520", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 56, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 52, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 60, "minimum": 60 } ] }, { "description": "Manual Diff", "code_information": [ { "code": "85007", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 32, "minimum": 32 } ] }, { "description": "TOTAL PROTEIN", "code_information": [ { "code": "84157", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 36, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 14, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 41, "minimum": 41 } ] }, { "description": "30 min post lactose dose", "code_information": [ { "code": "82951", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 37, "minimum": 37 } ] }, { "description": "60 min post lactose dose", "code_information": [ { "code": "82951", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 37, "minimum": 37 } ] }, { "description": "90 min post lactose dose", "code_information": [ { "code": "82951", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 37, "minimum": 37 } ] }, { "description": "120 min post lactose dose", "code_information": [ { "code": "82952", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 37, "minimum": 37 } ] }, { "description": "180 min post lactose dose", "code_information": [ { "code": "82952", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 37, "minimum": 37 } ] }, { "description": "210 min post lactose dose", "code_information": [ { "code": "82952", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 35, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 32, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 37, "minimum": 37 } ] }, { "description": "ALBUTEROL, SERUM/PLASMA", "code_information": [ { "code": "80299", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 306, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 306, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 306, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 299, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 280, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 113, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 113, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 113, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 113, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 113, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 322, "minimum": 322 } ] }, { "description": "XR--ACROMIOCLAVICULAR JOINT.BILATERAL--VIEWS^W \u0026 WO WEIGHT", "code_information": [ { "code": "73050", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 286, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 286, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 286, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 280, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 262, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 301, "minimum": 301 } ] }, { "description": "ACETONE", "code_information": [ { "code": "82010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 180, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 180, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 180, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 176, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 165, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 66, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 66, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 66, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 66, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 66, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 189, "minimum": 189 } ] }, { "description": "XR--ANKLE.RIGHT--VIEWS 2", "code_information": [ { "code": "73600", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 210, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 197, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 226, "minimum": 226 } ] }, { "description": "ANTIMONY, BLOOD", "code_information": [ { "code": "83018", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 119, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 111, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 128, "minimum": 128 } ] }, { "description": "XR--UPPER EXTREMITY.RIGHT--VIEWS (INFANT)", "code_information": [ { "code": "73092", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 194, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 194, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 194, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 190, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 178, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 204, "minimum": 204 } ] }, { "description": "XR--GASTROINTESTINAL SYSTEM+RESPIRATORY SYSTEM--VIEW FOR FOREIGN BODY", "code_information": [ { "code": "76010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 205, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 205, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 205, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 201, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 188, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 216, "minimum": 216 } ] }, { "description": "HIV 1/2 AG,AB W/RX,4GEN", "code_information": [ { "code": "87389", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 276, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 276, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 276, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 270, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 253, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 290, "minimum": 290 } ] }, { "description": "MUMPS VIRUS ANTIBODY (IGM)", "code_information": [ { "code": "86735", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 220, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 206, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 237, "minimum": 237 } ] }, { "description": "SOMATOSTATIN", "code_information": [ { "code": "84307", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 188, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 188, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 188, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 184, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 172, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 198, "minimum": 198 } ] }, { "description": "HEREDITARY HEMOCHROMATOSIS DNA MUTATION ANALYSIS", "code_information": [ { "code": "81256", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 749, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 749, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 749, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 733, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 686, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 276, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 276, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 276, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 276, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 276, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 788, "minimum": 788 } ] }, { "description": "Fibroblast Growth Factor 23, Quant, Plasma", "code_information": [ { "code": "83520", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 356, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 356, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 356, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 349, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 327, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 131, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 131, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 131, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 131, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 131, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 375, "minimum": 375 } ] }, { "description": "HAND - BILATERAL X-RAY ARTHRITIS", "code_information": [ { "code": "73120", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 205, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 205, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 205, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 201, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 188, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 216, "minimum": 216 } ] }, { "description": "CORTISOL, FREE, 24-HR URINE W/CREAT", "code_information": [ { "code": "82530", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 385, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 385, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 385, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 377, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 353, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 142, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 142, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 142, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 142, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 142, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 405, "minimum": 405 } ] }, { "description": "Free Cortisol", "code_information": [ { "code": "82530", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 220, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 220, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 220, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 216, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 202, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 81, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 81, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 81, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 81, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 81, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 232, "minimum": 232 } ] }, { "description": "CALCIUM, 24-HR URINE W/O CREAT", "code_information": [ { "code": "82340", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 132, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 132, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 132, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 129, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 121, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 49, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 49, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 49, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 49, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 49, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 139, "minimum": 139 } ] }, { "description": "XR--SPINE.LUMBAR--VIEW 1", "code_information": [ { "code": "72020", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 197, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 197, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 197, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 193, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 180, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 72, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 72, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 72, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 72, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 72, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 207, "minimum": 207 } ] }, { "description": "HEPATITIS BE ANTIGEN", "code_information": [ { "code": "87350", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 102, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 96, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 110, "minimum": 110 } ] }, { "description": "5-HYDROXYINDOLEACETIC ACID (5-HIAA), 24-HR URINE", "code_information": [ { "code": "83497", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 247, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 247, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 247, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 242, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 226, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 260, "minimum": 260 } ] }, { "description": "5 \u0027NUCLEOTIDASE", "code_information": [ { "code": "83915", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 150, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 150, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 150, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 147, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 138, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 158, "minimum": 158 } ] }, { "description": "ALDOSTERONE, SERUM", "code_information": [ { "code": "82088", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 336, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 336, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 336, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 329, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 308, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 354, "minimum": 354 } ] }, { "description": "HIV-1 RNA, QUANTITATIVE, REAL-TIME PCR", "code_information": [ { "code": "87536", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 812, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 812, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 812, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 795, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 745, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 299, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 299, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 299, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 299, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 299, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 855, "minimum": 855 } ] }, { "description": "ANGIOTENSIN CONVERTING ENZYME (ACE) POLYMORPHISM (INSERTION/DELETION)", "code_information": [ { "code": "81400", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 210, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 210, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 210, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 206, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 192, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 221, "minimum": 221 } ] }, { "description": "ACETONE, SEMI-QUANTITATIVE", "code_information": [ { "code": "82009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 36, "minimum": 36 } ] }, { "description": "ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY", "code_information": [ { "code": "83519", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 726, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 726, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 726, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 711, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 665, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 267, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 267, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 267, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 267, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 267, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 764, "minimum": 764 } ] }, { "description": "XR--CHEST--VIEW AP LATERAL-DECUBITUS", "code_information": [ { "code": "71048", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 232, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 232, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 232, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 227, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 213, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 244, "minimum": 244 } ] }, { "description": "XR--CHEST--VIEWS 4", "code_information": [ { "code": "71048", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 351, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 351, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 351, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 343, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 321, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 129, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 129, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 129, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 129, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 129, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 369, "minimum": 369 } ] }, { "description": "XR--ELBOW.LEFT--VIEWS 3", "code_information": [ { "code": "73080", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 238, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 238, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 238, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 232, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 88, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 88, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 88, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 88, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 88, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 250, "minimum": 250 } ] }, { "description": "XR--ESOPHAGUS--VIEWS^W CONTRAST PO", "code_information": [ { "code": "74220", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 437, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 437, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 437, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 428, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 401, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 161, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 161, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 161, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 161, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 161, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 460, "minimum": 460 } ] }, { "description": "XR--ORBIT.BILATERAL--VIEWS FOR FOREIGN BODY", "code_information": [ { "code": "70030", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 286, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 286, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 286, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 280, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 262, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 301, "minimum": 301 } ] }, { "description": "XR--FACIAL BONES--VIEWS 1 OR 2", "code_information": [ { "code": "70140", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 279, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 279, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 279, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 273, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 256, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 103, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 103, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 103, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 103, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 103, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 294, "minimum": 294 } ] }, { "description": "XR--FEMUR.RIGHT--VIEWS", "code_information": [ { "code": "73552", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 305, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 305, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 305, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 299, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 280, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 112, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 112, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 112, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 112, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 112, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 321, "minimum": 321 } ] }, { "description": "XR--FOOT.RIGHT--VIEWS 2", "code_information": [ { "code": "73620", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 210, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 197, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 226, "minimum": 226 } ] }, { "description": "FOOT - BILATERAL X-RAY AP SINGLE VIEW", "code_information": [ { "code": "0320", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 331, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 331, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 331, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 324, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 303, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 348, "minimum": 348 } ] }, { "description": "XR--HAND.RIGHT--VIEWS 2", "code_information": [ { "code": "73120", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 242, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 242, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 242, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 237, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 222, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 89, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 89, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 89, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 89, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 89, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 255, "minimum": 255 } ] }, { "description": "XR--KNEE.BILATERAL--VIEWS \u0026 (VIEW AP^STANDING)", "code_information": [ { "code": "73565", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 258, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 258, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 258, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 253, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 237, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 95, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 95, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 95, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 95, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 95, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 272, "minimum": 272 } ] }, { "description": "KNEE - BILATERAL X-RAY 2 VIEWS STANDING", "code_information": [ { "code": "73565", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 352, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 352, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 352, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 345, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 323, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 371, "minimum": 371 } ] }, { "description": "XR--MANDIBLE--VIEWS LIMITED", "code_information": [ { "code": "70100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 325, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 325, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 325, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 318, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 298, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 120, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 120, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 120, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 120, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 120, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 342, "minimum": 342 } ] }, { "description": "XR--MASTOID.RIGHT--VIEWS 3", "code_information": [ { "code": "70130", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 584, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 584, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 584, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 572, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 536, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 615, "minimum": 615 } ] }, { "description": "XR--OPTIC FORAMEN.BILATERAL--VIEWS", "code_information": [ { "code": "70190", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 290, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 290, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 290, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 284, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 266, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 305, "minimum": 305 } ] }, { "description": "XR--ORBIT.BILATERAL--VIEWS 4", "code_information": [ { "code": "70200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 390, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 390, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 390, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 382, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 358, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 144, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 144, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 144, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 144, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 144, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 411, "minimum": 411 } ] }, { "description": "XR--PELVIS--VIEWS 3", "code_information": [ { "code": "72190", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 325, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 325, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 325, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 318, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 298, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 120, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 120, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 120, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 120, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 120, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 342, "minimum": 342 } ] }, { "description": "SC JOINTS MIN 3 VIEWS (STERNAL CLAVICULAR)", "code_information": [ { "code": "71130", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 295, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 295, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 295, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 289, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 271, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 109, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 109, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 109, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 109, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 109, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 311, "minimum": 311 } ] }, { "description": "XR--SELLA TURCICA--VIEWS", "code_information": [ { "code": "70240", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 246, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 246, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 246, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 241, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 226, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 259, "minimum": 259 } ] }, { "description": "XR--SINUSES--VIEWS 1 OR 2", "code_information": [ { "code": "70210", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 305, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 305, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 305, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 299, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 280, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 112, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 112, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 112, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 112, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 112, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 321, "minimum": 321 } ] }, { "description": "XR--SKULL--VIEWS 4", "code_information": [ { "code": "70260", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 412, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 412, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 412, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 404, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 378, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 152, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 152, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 152, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 152, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 152, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 434, "minimum": 434 } ] }, { "description": "XR--ABDOMEN--VIEWS (SITZMARK)", "code_information": [ { "code": "74250", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 579, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 579, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 579, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 566, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 530, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 213, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 213, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 213, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 213, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 213, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 609, "minimum": 609 } ] }, { "description": "XR--TIBIA.RIGHT+FIBULA.RIGHT--VIEWS 2", "code_information": [ { "code": "73590", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 396, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 396, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 396, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 388, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 363, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 146, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 146, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 146, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 146, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 146, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 417, "minimum": 417 } ] }, { "description": "XR--GREAT TOE.LEFT--VIEWS", "code_information": [ { "code": "73660", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 220, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 206, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 237, "minimum": 237 } ] }, { "description": "XR--TOE.THIRD.LEFT--VIEWS", "code_information": [ { "code": "73660", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 213, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 199, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 229, "minimum": 229 } ] }, { "description": "XR--TOE.FOURTH.LEFT--VIEWS", "code_information": [ { "code": "73660", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 213, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 199, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 229, "minimum": 229 } ] }, { "description": "XR--TOE.FIFTH.LEFT--VIEWS", "code_information": [ { "code": "73660", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 213, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 199, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 229, "minimum": 229 } ] }, { "description": "XR--GREAT TOE.RIGHT--VIEWS", "code_information": [ { "code": "73660", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 220, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 206, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 237, "minimum": 237 } ] }, { "description": "XR--TOE.THIRD.RIGHT--VIEWS", "code_information": [ { "code": "73660", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 213, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 199, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 229, "minimum": 229 } ] }, { "description": "XR--TOE.FOURTH.RIGHT--VIEWS", "code_information": [ { "code": "73660", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 213, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 199, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 229, "minimum": 229 } ] }, { "description": "XR--TOE.FIFTH.RIGHT--VIEWS", "code_information": [ { "code": "73660", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 213, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 199, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 80, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 229, "minimum": 229 } ] }, { "description": "XR--WRIST.RIGHT--VIEWS 2", "code_information": [ { "code": "73100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 237, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 237, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 237, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 232, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 217, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 249, "minimum": 249 } ] }, { "description": "XR--LOWER EXTREMITY.RIGHT--VIEWS", "code_information": [ { "code": "73592", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 194, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 194, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 194, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 190, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 178, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 204, "minimum": 204 } ] }, { "description": "XR--ANKLE.LEFT--VIEWS 2", "code_information": [ { "code": "73600", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 210, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 197, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 226, "minimum": 226 } ] }, { "description": "XR--UPPER EXTREMITY.LEFT--VIEWS (INFANT)", "code_information": [ { "code": "73092", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 194, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 194, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 194, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 190, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 178, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 204, "minimum": 204 } ] }, { "description": "XR--ELBOW.RIGHT--VIEWS 3", "code_information": [ { "code": "73080", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 238, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 238, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 238, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 232, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 218, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 88, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 88, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 88, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 88, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 88, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 250, "minimum": 250 } ] }, { "description": "XR--FOOT.LEFT--VIEWS 2", "code_information": [ { "code": "73620", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 215, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 210, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 197, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 79, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 226, "minimum": 226 } ] }, { "description": "XR--HAND.LEFT--VIEWS 2", "code_information": [ { "code": "73120", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 232, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 232, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 232, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 227, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 213, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 85, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 244, "minimum": 244 } ] }, { "description": "XR--HIP.LEFT--VIEW 1", "code_information": [ { "code": "73501", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 254, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 254, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 254, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 248, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 233, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 93, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 93, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 93, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 93, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 93, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 267, "minimum": 267 } ] }, { "description": "XR--TIBIA.LEFT+FIBULA.LEFT--VIEWS 2", "code_information": [ { "code": "73590", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 396, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 396, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 396, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 388, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 363, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 146, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 146, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 146, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 146, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 146, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 417, "minimum": 417 } ] }, { "description": "XR--WRIST.LEFT--VIEWS 2", "code_information": [ { "code": "73100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 237, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 237, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 237, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 232, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 217, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 249, "minimum": 249 } ] }, { "description": "CT CHEST/ABDOMEN WITH IV CONTRAST", "code_information": [ { "code": "0350", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 4069, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 4069, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 4069, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 3983, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 3730, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1499, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1499, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1499, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1499, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1499, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 4283, "minimum": 4283 } ] }, { "description": "CT CHEST/ABDOMEN W/O IV CONTRAST", "code_information": [ { "code": "0350", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 3052, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 3052, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 3052, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 2988, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 2799, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1125, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1125, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1125, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1125, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1125, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 3213, "minimum": 3213 } ] }, { "description": "SINUSES LIMITED OR FOLLOW UP CT", "code_information": [ { "code": "76380", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 600, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 600, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 600, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 588, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 550, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 221, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 221, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 221, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 221, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 221, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 632, "minimum": 632 } ] }, { "description": "CT--SINUSES--MULTISECTION CORONAL SAGITTAL", "code_information": [ { "code": "70486,TC", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 2046, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 2046, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 2046, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 2003, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1876, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 754, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 754, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 754, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 754, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 754, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 2154, "minimum": 2154 } ] }, { "description": "ORBIT WO/W CONTRAST", "code_information": [ { "code": "70482", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 2057, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 2057, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 2057, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 2013, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1886, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 758, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 758, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 758, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 758, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 758, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 2165, "minimum": 2165 } ] }, { "description": "UPPER EXTREMITY RT WO/W CONTR", "code_information": [ { "code": "73202", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 2137, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 2137, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 2137, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 2092, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1959, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 787, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 787, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 787, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 787, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 787, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 2249, "minimum": 2249 } ] }, { "description": "BONE DENSITY SPINE / HIP", "code_information": [ { "code": "77078,TC", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 461, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 461, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 461, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 451, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 422, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 170, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 170, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 170, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 170, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 170, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 485, "minimum": 485 } ] }, { "description": "IV CONTRAST UP TO 50CC", "code_information": [ { "code": "Q9967,LO", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 90, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 90, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 90, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 88, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 95, "minimum": 95 } ] }, { "description": "IV CONTRAST UP TO 150CC", "code_information": [ { "code": "Q9967,HI", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 302, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 302, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 302, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 296, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 277, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 111, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 111, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 111, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 111, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 111, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 318, "minimum": 318 } ] }, { "description": "CT ABD PELVIS W / O CONTRAST", "code_information": [ { "code": "74176", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 3163, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 3163, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 3163, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 3096, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 2900, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1165, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1165, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1165, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1165, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1165, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 3329, "minimum": 3329 } ] }, { "description": "CT--ABDOMEN PELVIS IV AND ORAL WITH CONTRAST", "code_information": [ { "code": "74177", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 4180, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 4180, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 4180, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 4092, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 3832, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1540, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1540, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1540, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1540, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1540, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 4400, "minimum": 4400 } ] }, { "description": "CT--ABDOMEN PELVIS IV ONLY", "code_information": [ { "code": "74177,TC", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 4180, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 4180, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 4180, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 4092, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 3832, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1540, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1540, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1540, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1540, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1540, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 4400, "minimum": 4400 } ] }, { "description": "CT ANGIO-RENAL VESSALS-W AND WO CONTRAST", "code_information": [ { "code": "75733", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1926, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1926, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1926, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1885, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1766, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 709, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 709, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 709, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 709, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 709, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 2027, "minimum": 2027 } ] }, { "description": "CTA RT LEG W/IV", "code_information": [ { "code": "73706", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 2282, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 2282, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 2282, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 2234, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 2092, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 841, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 841, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 841, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 841, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 841, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 2402, "minimum": 2402 } ] }, { "description": "CTA BILAT LEG W/IV", "code_information": [ { "code": "73706", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 3410, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 3410, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 3410, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 3338, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 3126, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1256, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1256, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1256, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1256, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1256, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 3589, "minimum": 3589 } ] }, { "description": "MRI CHEST WO", "code_information": [ { "code": "71550", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 2294, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 2294, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 2294, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 2246, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 2103, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 845, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 845, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 845, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 845, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 845, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 2415, "minimum": 2415 } ] }, { "description": "MRI CHEST WO/W", "code_information": [ { "code": "71552,TC", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 2992, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 2992, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 2992, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 2930, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 2744, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 3150, "minimum": 3150 } ] }, { "description": "MRI CHEST W", "code_information": [ { "code": "71552", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 2992, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 2992, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 2992, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 2930, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 2744, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 3150, "minimum": 3150 } ] }, { "description": "UE LT NON JNT WO/W CONTR", "code_information": [ { "code": "73220", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 2427, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 2427, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 2427, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 2376, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 2225, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 894, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 894, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 894, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 894, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 894, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 2555, "minimum": 2555 } ] }, { "description": "LIVER ULTRA SOUND", "code_information": [ { "code": "76705", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 474, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 474, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 474, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 464, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 435, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 175, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 175, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 175, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 175, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 175, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 499, "minimum": 499 } ] }, { "description": "RETROPERITONEAL (EG, RENAL, AORTA, NODES) US LIMITED", "code_information": [ { "code": "76775", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 544, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 544, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 544, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 533, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 499, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 201, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 201, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 201, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 201, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 201, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 573, "minimum": 573 } ] }, { "description": "DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONINUOUS WAVE W/ SPECTRAL DISPLAY: COMPLETE", "code_information": [ { "code": "93320", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 818, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 818, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 818, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 801, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 750, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 301, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 301, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 301, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 301, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 301, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 861, "minimum": 861 } ] }, { "description": "DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE W/ SPECTRAL DISPLAY: FOLLOW-UP OR LIMITED STUDY", "code_information": [ { "code": "93321", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 773, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 773, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 773, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 757, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 709, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 285, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 285, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 285, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 285, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 285, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 814, "minimum": 814 } ] }, { "description": "DOPPLER ECHOCARDIOGRAPHY COLOR FLOW VELOCITY MAPPING", "code_information": [ { "code": "93325", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 758, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 758, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 758, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 742, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 695, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 279, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 279, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 279, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 279, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 279, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 798, "minimum": 798 } ] }, { "description": "U/S GUIDANCE NEEDL BIOPSY", "code_information": [ { "code": "76942", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 482, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 482, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 482, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 472, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 442, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 177, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 177, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 177, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 177, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 177, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 507, "minimum": 507 } ] }, { "description": "BREAST LT ULTRA SOUND", "code_information": [ { "code": "77061", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 247, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 247, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 247, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 242, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 226, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 260, "minimum": 260 } ] }, { "description": "UNLISTED THERAPY PROC", "code_information": [ { "code": "97139", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 50, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 50, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 50, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 49, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 53, "minimum": 53 } ] }, { "description": "PHYS PERFORM TEST EVAL", "code_information": [ { "code": "97750", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 56, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 56, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 56, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 51, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 59, "minimum": 59 } ] }, { "description": "PROSTHETIC TRAIN EA 15", "code_information": [ { "code": "97761", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 47, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 44, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 51, "minimum": 51 } ] }, { "description": "WHIRLPOOL", "code_information": [ { "code": "97022", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 58, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 58, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 58, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 53, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 61, "minimum": 61 } ] }, { "description": "MYOFASCIAL/SOFT TISSUE", "code_information": [ { "code": "97140", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 66, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 66, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 66, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 64, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 60, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 69, "minimum": 69 } ] }, { "description": "ORTHOTICS FIT/TRAIN 15", "code_information": [ { "code": "97760", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 48, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 44, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 18, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 50, "minimum": 50 } ] }, { "description": "UNLISTED THERAPY PROCEDUR", "code_information": [ { "code": "97139", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 58, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 58, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 58, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 53, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 61, "minimum": 61 } ] }, { "description": "UNLISTED MODALITY", "code_information": [ { "code": "97039", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 58, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 58, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 58, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 53, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 61, "minimum": 61 } ] }, { "description": "TAPING PROCEDURE", "code_information": [ { "code": "97799", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 65, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 65, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 65, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 63, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 59, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 68, "minimum": 68 } ] }, { "description": "ELECTRODES SET OF 4", "code_information": [ { "code": "97799", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 23, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 22, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 25, "minimum": 25 } ] }, { "description": "IONTO ELECTRODES", "code_information": [ { "code": "97799", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 28, "minimum": 28 } ] }, { "description": "BRACE MOD/UNLST REHAB", "code_information": [ { "code": "97799", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 56, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 56, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 56, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 51, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 59, "minimum": 59 } ] }, { "description": "ROM MEAS.\u0026 RPT EACH EXTRE", "code_information": [ { "code": "95851", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 74, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 74, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 74, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 73, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 68, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 78, "minimum": 78 } ] }, { "description": "CANALITH REPOSITIONING", "code_information": [ { "code": "95992", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 100, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 100, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 100, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 105, "minimum": 105 } ] }, { "description": "P/T EVAL MOD COMPLEX 30 MINS", "code_information": [ { "code": "97162", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 288, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 288, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 288, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 282, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 264, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 106, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 106, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 106, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 106, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 106, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 303, "minimum": 303 } ] }, { "description": "P/T EVAL HIGH COMPLEX 45 MINS", "code_information": [ { "code": "97163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 346, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 346, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 346, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 339, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 317, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 127, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 127, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 127, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 127, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 127, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 364, "minimum": 364 } ] }, { "description": "ASSIST TECH ASSESS-1 ON 1", "code_information": [ { "code": "97755", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 103, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 97, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 111, "minimum": 111 } ] }, { "description": "IV THER CONCUR INFUS", "code_information": [ { "code": "96368", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 142, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 142, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 142, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 139, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 52, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 52, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 52, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 52, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 52, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 149, "minimum": 149 } ] }, { "description": "MNT; REASSESSMENT \u0026 SUBS INTERVENTION; MNT SUBS TREATMENT CHANGE IN DIAG; EACH 15 MIN", "code_information": [ { "code": "G0270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 50, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 50, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 50, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 49, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 19, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 53, "minimum": 53 } ] }, { "description": "MNT; REASSESSMENT \u0026 SUBS INTERVENTION; GROUP MNT 2 OR MORE; EACH 30 MIN", "code_information": [ { "code": "G0271", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 28, "minimum": 28 } ] }, { "description": "DRESSING CHANGE SIMPLE", "code_information": [ { "code": "99211,DC", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 26, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 24, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 28, "minimum": 28 } ] }, { "description": "BLADDER CATH NON INDWELL", "code_information": [ { "code": "51701", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 148, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 148, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 148, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 145, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 136, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 156, "minimum": 156 } ] }, { "description": "TREATMENT ROOM PER HR", "code_information": [ { "code": "99211", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 122, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 119, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 111, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 128, "minimum": 128 } ] }, { "description": "TREATMENT ROOM, MINIMAL", "code_information": [ { "code": "99211,TR", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 56, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 56, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 56, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 51, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 21, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 59, "minimum": 59 } ] }, { "description": "OP TREATMENT/SHORT STAY", "code_information": [ { "code": "99211", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 138, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 138, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 138, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 135, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 126, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 51, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 51, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 51, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 51, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 51, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 145, "minimum": 145 } ] }, { "description": "INJ FEE ALLERGY (X1)", "code_information": [ { "code": "95115", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 11, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 32, "minimum": 32 } ] }, { "description": "INJ FEE ALLERGY (X2)", "code_information": [ { "code": "95117", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 40, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 15, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 43, "minimum": 43 } ] }, { "description": "COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE", "code_information": [ { "code": "36591", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 34, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 33, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 31, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 13, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 36, "minimum": 36 } ] }, { "description": "WHIRLPOOL BATH - OUTPATIENT NURSING SERVICES", "code_information": [ { "code": "97022", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 55, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 54, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 51, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 20, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 58, "minimum": 58 } ] }, { "description": "IV THER CONCUR INFUS", "code_information": [ { "code": "96368", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 142, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 142, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 142, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 139, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 130, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 52, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 52, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 52, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 52, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 52, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 149, "minimum": 149 } ] }, { "description": "MNT; GROUP, 2 OR MORE, EACH 30 MIN", "code_information": [ { "code": "97804", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 28, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 27, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 25, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 10, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 29, "minimum": 29 } ] }, { "description": "FETAL NON-STRESS", "code_information": [ { "code": "59025", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 187, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 187, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 187, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 183, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 172, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 197, "minimum": 197 } ] }, { "description": "PSYCHIATRIC DIAGNOSTIC EVALUATION", "code_information": [ { "code": "90791", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 237, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 237, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 237, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 232, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 217, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 87, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 249, "minimum": 249 } ] }, { "description": "45 MIN PSYCHOTHERAPY", "code_information": [ { "code": "90836", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 171, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 171, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 171, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 167, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 157, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 63, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 63, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 63, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 63, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 63, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 180, "minimum": 180 } ] }, { "description": "PSY CONSULT 1 - ER", "code_information": [ { "code": "99281", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 81, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 87, "minimum": 87 } ] }, { "description": "PSY CONSULT 2 - ER", "code_information": [ { "code": "99282", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 154, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 154, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 154, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 151, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 141, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 57, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 162, "minimum": 162 } ] }, { "description": "PSY CONSULT 3 - ER", "code_information": [ { "code": "99283", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 210, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 210, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 210, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 206, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 192, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 77, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 221, "minimum": 221 } ] }, { "description": "PSY CONSULT 4 - ER", "code_information": [ { "code": "99284", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 308, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 308, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 308, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 301, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 282, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 113, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 113, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 113, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 113, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 113, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 324, "minimum": 324 } ] }, { "description": "PSY CONSULT 5 - ER", "code_information": [ { "code": "99285", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 374, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 374, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 374, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 366, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 343, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 138, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 138, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 138, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 138, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 138, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 394, "minimum": 394 } ] }, { "description": "PSY CONSULT 1 - IP", "code_information": [ { "code": "99499", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 83, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 81, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 76, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 30, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 87, "minimum": 87 } ] }, { "description": "PSY CONSULT 2 - IP", "code_information": [ { "code": "99499", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 126, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 126, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 126, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 116, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 47, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 47, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 47, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 47, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 47, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 133, "minimum": 133 } ] }, { "description": "PSY CONSULT 3 - IP", "code_information": [ { "code": "99221", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 187, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 187, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 187, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 183, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 172, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 69, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 197, "minimum": 197 } ] }, { "description": "PSY CONSULT 4 - IP", "code_information": [ { "code": "99222", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 276, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 276, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 276, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 270, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 253, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 102, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 290, "minimum": 290 } ] }, { "description": "PSY CONSULT 5 - IP", "code_information": [ { "code": "99223", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 335, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 335, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 335, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 328, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 307, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 124, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 353, "minimum": 353 } ] }, { "description": "SPEECH DYSPHAGIA TX-15MIN", "code_information": [ { "code": "92526", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 46, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 45, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 42, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 17, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 48, "minimum": 48 } ] }, { "description": "AUDIOMETRY EVAL", "code_information": [ { "code": "92557", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 194, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 194, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 194, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 190, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 178, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 71, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 204, "minimum": 204 } ] }, { "description": "HEARING AID CHK, MONAURAL", "code_information": [ { "code": "92592", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 103, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 103, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 103, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 100, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 94, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 38, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 108, "minimum": 108 } ] }, { "description": "STD COGNITIVE PERFOR TEST", "code_information": [ { "code": "96125", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 102, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 96, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 110, "minimum": 110 } ] }, { "description": "COMPLEX CATARACT SURG LT", "code_information": [ { "code": "66982,LT", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 3959, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 3959, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 3959, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 3875, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 3629, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 4167, "minimum": 4167 } ] }, { "description": "TRABECULOPLASTY", "code_information": [ { "code": "65855", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 610, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 610, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 610, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 597, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 559, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 642, "minimum": 642 } ] }, { "description": "INTRACAP CATARACT REMV LT", "code_information": [ { "code": "66983,LT", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 3629, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 3629, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 3629, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 3553, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 3327, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1337, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1337, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1337, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1337, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1337, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 3820, "minimum": 3820 } ] }, { "description": "EXTRACAP CATARACT REMV LT", "code_information": [ { "code": "66984,LT", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 3959, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 3959, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 3959, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 3875, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 3629, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 4167, "minimum": 4167 } ] }, { "description": "LASER PERIPH IRIDOTOMY LT", "code_information": [ { "code": "66761", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 610, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 610, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 610, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 597, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 559, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 642, "minimum": 642 } ] }, { "description": "LASER PERIPH IRIDOTOMY RT", "code_information": [ { "code": "66761", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 610, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 610, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 610, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 597, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 559, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 225, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 642, "minimum": 642 } ] }, { "description": "DEST LES LID MARGN TO 1CM", "code_information": [ { "code": "67850", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 791, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 791, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 791, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 775, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 726, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 292, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 292, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 292, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 292, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 292, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 833, "minimum": 833 } ] }, { "description": "COMPLEX CATARACT SURG RT", "code_information": [ { "code": "66982,RT", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 3959, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 3959, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 3959, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 3875, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 3629, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 4167, "minimum": 4167 } ] }, { "description": "INTRACAP CATARACT REMV RT", "code_information": [ { "code": "66983,RT", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 3629, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 3629, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 3629, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 3553, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 3327, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1337, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1337, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1337, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1337, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1337, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 3820, "minimum": 3820 } ] }, { "description": "EXTRACAP CATARACT REMV RT", "code_information": [ { "code": "66984,RT", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 3959, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 3959, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 3959, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 3875, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 3629, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1458, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 4167, "minimum": 4167 } ] }, { "description": "IRIDECTOMY", "code_information": [ { "code": "66985", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 2090, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 2090, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 2090, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 2046, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1916, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 770, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 770, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 770, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 770, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 770, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 2200, "minimum": 2200 } ] }, { "description": "ANESTHESIA IV SED PER MIN", "code_information": [ { "code": "0370", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 9, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 8, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 3, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 9, "minimum": 9 } ] }, { "description": "ANESTHESIA CRNA PER UNIT", "code_information": [ { "code": "0370", "type": "RC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 105, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 103, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 97, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 39, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 111, "minimum": 111 } ] }, { "description": "OFFICE CONSULT L3 EST", "code_information": [ { "code": "99213,CS", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 319, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 319, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 319, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 312, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 293, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 118, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 118, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 118, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 118, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 118, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 336, "minimum": 336 } ] }, { "description": "OFFICE CONSULT L5 EST", "code_information": [ { "code": "99215,CS", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 540, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 540, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 540, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 528, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 495, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 199, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 199, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 199, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 199, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 199, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 568, "minimum": 568 } ] }, { "description": "PEG TUBE REMOVAL", "code_information": [ { "code": "43500", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 110, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 110, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 110, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 108, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 101, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 41, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 116, "minimum": 116 } ] }, { "description": "EST OFF VST-STRAIGHT FWD", "code_information": [ { "code": "99212,OF", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 100, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 100, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 100, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 98, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 91, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 37, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 105, "minimum": 105 } ] }, { "description": "OFFICE CONSULT L2 NEW", "code_information": [ { "code": "99202", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 292, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 292, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 292, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 286, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 267, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 107, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 307, "minimum": 307 } ] }, { "description": "OFFICE CONSULT L3 NEW", "code_information": [ { "code": "99203", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 363, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 363, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 363, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 355, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 333, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 134, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 134, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 134, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 134, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 134, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 382, "minimum": 382 } ] }, { "description": "OFFICE CONSULT L4 NEW", "code_information": [ { "code": "99204", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 484, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 484, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 484, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 473, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 443, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 178, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 178, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 178, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 178, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 178, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 509, "minimum": 509 } ] }, { "description": "OFFICE CONSULT L5 NEW", "code_information": [ { "code": "99205", "type": "HCPCS" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 605, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 605, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 605, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 592, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 555, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 223, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 223, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 223, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 223, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 223, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 637, "minimum": 637 } ] }, { "description": "ACETAMINOPHEN 120 MG-CODEINE 12 MG/5 ML ORAL SOLUTION", "drug_information": { "unit": "5", "type": "ML" }, "code_information": [ { "code": "50383007916", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "MAPAP (ACETAMINOPHEN) 325 MG TABLET", "drug_information": { "unit": "325", "type": "UN" }, "code_information": [ { "code": "63739044001", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "MAPAP EXTRA STRENGTH 500 MG TABLET", "drug_information": { "unit": "500", "type": "UN" }, "code_information": [ { "code": "00904198880", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "ACETAZOLAMIDE 500 MG/VIAL, J1120 - INJECTION, UP TO 500 MG", "drug_information": { "unit": "500", "type": "GR" }, "code_information": [ { "code": "25021081710", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "ACYCLOVIR 200 MG CAPSULE", "drug_information": { "unit": "200", "type": "UN" }, "code_information": [ { "code": "00093894001", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "ADENOSINE 6 MG/SYR (3 MG/ML), J0153 - INJECTION, PER 1 MG", "drug_information": { "unit": "1", "type": "GR" }, "code_information": [ { "code": "00469823412", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "CHILD PAIN-FEVER 160 MG/5 ML 5 mL, 118 mL", "drug_information": { "unit": "5", "type": "ML" }, "code_information": [ { "code": "50580042401", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "ACIDOPHILUS CAPLET 1 ea, 100 eaches", "drug_information": { "unit": "1", "type": "UN" }, "code_information": [ { "code": "00536718001", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "VITAMIN C 500 MG TABLET 500 mg, 100 eaches", "drug_information": { "unit": "500", "type": "UN" }, "code_information": [ { "code": "00904052361", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "atorvastatin 20 MG TABLET 20 ea, 100 eaches", "drug_information": { "unit": "20", "type": "UN" }, "code_information": [ { "code": "00904629161", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "carvedilol 12.5 MG TABLET 12.5 ea, 100 eaches", "drug_information": { "unit": "12.5", "type": "UN" }, "code_information": [ { "code": "00904630261", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "DEXTROSE 25%-WATER SYRINGE 1 ea, 10 mL", "drug_information": { "unit": "1", "type": "GR" }, "code_information": [ { "code": "00409177510", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "DOPamine 800 MG-D5W 250 ML 40 mg, 250 mL", "drug_information": { "unit": "40", "type": "GR" }, "code_information": [ { "code": "00409781022", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "ALBUTEROL SULFATE 2 MG/5 ML SYRUP", "drug_information": { "unit": "5", "type": "ML" }, "code_information": [ { "code": "00093066116", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "DOXYCYCLINE MONO 100 MG CAP 100 mg, 20 eaches", "drug_information": { "unit": "100", "type": "UN" }, "code_information": [ { "code": "68084074332", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "ENOXAPARIN 60 MG/0.6 ML SYR 1 mg, 0.6 mL", "drug_information": { "unit": "10", "type": "GR" }, "code_information": [ { "code": "63323056888", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage" }, { "payer_name": "Humana W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Humana W/ Medicare Advantage" }, { "payer_name": "Healthplan Nevada W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Healthplan Nevada W/ Medicare Advantage" }, { "payer_name": "Sierra Health and Life W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Sierra Health and Life W/ Medicare Advantage" } ], "maximum": 1, "minimum": 1 } ] }, { "description": "ENOXAPARIN 80 MG/0.8 ML SYR 1 mg, 0.8 mL", "drug_information": { "unit": "10", "type": "GR" }, "code_information": [ { "code": "63323056890", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "payers_information": [ { "payer_name": "Anthem Blue Cross", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Anthem Blue Cross" }, { "payer_name": "Hometown Health", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Hometown Health" }, { "payer_name": "Prominence", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 95, "methodology": "percent of total billed charges", "plan_name": "Prominence" }, { "payer_name": "Silver Summit", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 93, "methodology": "percent of total billed charges", "plan_name": "Silver Summit" }, { "payer_name": "Aetna", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 87.1, "methodology": "percent of total billed charges", "plan_name": "Aetna" }, { "payer_name": "Aetna W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Aetna W/ Medicare Advantage" }, { "payer_name": "Optumcare W/ Medicare Advantage", "negotiated_type": "percentage", "estimated_amount": 1, "standard_charge_percentage": 35, "methodology": "percent of total billed charges", "plan_name": "Optumcare W/ Medicare Advantage"