{ "hospital_name": "SBH-Kingsport, LLC", "last_updated_on": "2026-05-20", "version": "3.0.0", "location_name": [ "Creekside Behavioral Health" ], "hospital_address": [ "1025 Executive Park Blvd, Kingsport, TN 37660" ], "license_information": { "state": "TN", "license_number": "136" }, "type_2_npi": [ "1174038749" ], "attestation": { "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Ric McAllister" }, "standard_charge_information": [ { "description": "Bridge Services", "code_information": [ { "code": "H0032", "type": "HCPCS" }, { "code": "785", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana - Commerical", "plan_name": "Humana - Commerical", "standard_charge_dollar": 100.0, "methodology": "fee schedule" } ], "minimum": 100.0, "maximum": 100.0 } ] }, { "description": "Acute Phych Adol R&B", "code_information": [ { "code": "124", "type": "RC" }, { "code": "702", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "90 Degree Benefits - MCA Administrators", "plan_name": "90 Degree Benefits - MCA Administrators", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "AARP United Healthcare Claim Division", "plan_name": "AARP United Healthcare Claim Division", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Administrative Concepts", "plan_name": "Administrative Concepts", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 1306.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of KY", "plan_name": "Aetna Better Health Of KY", "standard_charge_dollar": 1030.91, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare PPO", "plan_name": "Aetna Medicare PPO", "standard_charge_dollar": 1214.0, "methodology": "fee schedule" }, { "payer_name": "AllCare Health-Oregon Mediciad", "plan_name": "AllCare Health-Oregon Mediciad", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Allied Benefits", "plan_name": "Allied Benefits", "standard_charge_dollar": 1184.0, "methodology": "fee schedule" }, { "payer_name": "Ambetter", "plan_name": "Ambetter", "standard_charge_dollar": 880.0, "methodology": "fee schedule" }, { "payer_name": "American Behavioral", "plan_name": "American Behavioral", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Amerihealth - NC Medicaid", "plan_name": "Amerihealth - NC Medicaid", "standard_charge_dollar": 630.0, "methodology": "fee schedule" }, { "payer_name": "Amerihealth Caritas Louisiana", "plan_name": "Amerihealth Caritas Louisiana", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "ASR Health Benefits", "plan_name": "ASR Health Benefits", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HOME PLAN", "plan_name": "BCBS HOME PLAN", "standard_charge_dollar": 1050.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "BCBS NC", "plan_name": "BCBS NC", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Virginia", "plan_name": "BCBS Virginia", "standard_charge_dollar": 1082.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options (Commerical)", "plan_name": "Beacon Health Options (Commerical)", "standard_charge_dollar": 1034.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Hlth Options Medicare", "plan_name": "Beacon Hlth Options Medicare", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Behavioral Health Systems", "plan_name": "Behavioral Health Systems", "standard_charge_dollar": 950.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Admin C/O Zelis", "plan_name": "Benefit Admin C/O Zelis", "standard_charge_dollar": 1000.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Administrative Services", "plan_name": "Benefit Administrative Services", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Bind Benefits", "plan_name": "Bind Benefits", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "Bluecare Plus Medicare", "plan_name": "Bluecare Plus Medicare", "standard_charge_dollar": 1960.0, "methodology": "fee schedule" }, { "payer_name": "Boon Administrative Services", "plan_name": "Boon Administrative Services", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Bright Health Plan", "plan_name": "Bright Health Plan", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Bureau Of TennCare", "plan_name": "Bureau Of TennCare", "standard_charge_dollar": 570.65, "methodology": "fee schedule" }, { "payer_name": "Carelon", "plan_name": "Carelon", "standard_charge_dollar": 1082.0, "methodology": "fee schedule" }, { "payer_name": "Carelon Behavioral Health", "plan_name": "Carelon Behavioral Health", "standard_charge_dollar": 1034.0, "methodology": "fee schedule" }, { "payer_name": "Cigna", "plan_name": "Cigna", "standard_charge_dollar": 1118.0, "methodology": "fee schedule" }, { "payer_name": "Cigna/Allied Health/Oscar", "plan_name": "Cigna/Allied Health/Oscar", "standard_charge_dollar": 1155.0, "methodology": "fee schedule" }, { "payer_name": "Clear Chain", "plan_name": "Clear Chain", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Community Care Behavioral Health Medicai", "plan_name": "Community Care Behavioral Health Medicai", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "ComPsych", "plan_name": "ComPsych", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Eastman Chemical Company", "plan_name": "Eastman Chemical Company", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Evolution Healthcare", "plan_name": "Evolution Healthcare", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Farm Bureau Commerical Policy", "plan_name": "Farm Bureau Commerical Policy", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Fidelis Care", "plan_name": "Fidelis Care", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "GEHA", "plan_name": "GEHA", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "Global Choice KY Medicaid", "plan_name": "Global Choice KY Medicaid", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Golden Rule Ins Company", "plan_name": "Golden Rule Ins Company", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "Health Cost Solutions", "plan_name": "Health Cost Solutions", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Health Plans", "plan_name": "Health Plans", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Health Smart", "plan_name": "Health Smart", "standard_charge_dollar": 1300.0, "methodology": "fee schedule" }, { "payer_name": "Healthcomp", "plan_name": "Healthcomp", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Healthscope", "plan_name": "Healthscope", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Highlands CSB - Lipos/Sarpos", "plan_name": "Highlands CSB - Lipos/Sarpos", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Humana - Commerical", "plan_name": "Humana - Commerical", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Illinois Meridian Medicaid", "plan_name": "Illinois Meridian Medicaid", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Imagine 360/Group & Pension Admin", "plan_name": "Imagine 360/Group & Pension Admin", "standard_charge_dollar": 800.64, "methodology": "fee schedule" }, { "payer_name": "Indiana Medicaid - Anthem BCBS", "plan_name": "Indiana Medicaid - Anthem BCBS", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Iowa Medicaid - Wellpoint", "plan_name": "Iowa Medicaid - Wellpoint", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Kaiser Permanente Of GA - Commercial", "plan_name": "Kaiser Permanente Of GA - Commercial", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Kentucky Health Administrators", "plan_name": "Kentucky Health Administrators", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Keystone First - PA Medicaid BCBS", "plan_name": "Keystone First - PA Medicaid BCBS", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "KY Medicaid - Wellcare", "plan_name": "KY Medicaid - Wellcare", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "KY Medicaid Community Plan", "plan_name": "KY Medicaid Community Plan", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "LA UHC Medicaid", "plan_name": "LA UHC Medicaid", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Lineco", "plan_name": "Lineco", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Louisiana Healthcare Connections", "plan_name": "Louisiana Healthcare Connections", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Lucent Health", "plan_name": "Lucent Health", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Magellan Healthcare Commerical Plan", "plan_name": "Magellan Healthcare Commerical Plan", "standard_charge_dollar": 1051.0, "methodology": "fee schedule" }, { "payer_name": "Magnacare", "plan_name": "Magnacare", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Medcost Benefit Services", "plan_name": "Medcost Benefit Services", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Medi-Share", "plan_name": "Medi-Share", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Medica Behavioral Health", "plan_name": "Medica Behavioral Health", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Meritain Health", "plan_name": "Meritain Health", "standard_charge_dollar": 1155.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare Of NY Medicaid", "plan_name": "Molina Healthcare Of NY Medicaid", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Molina Of Michigan", "plan_name": "Molina Of Michigan", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Mount Rogers CSB - Lipos/Sarpos", "plan_name": "Mount Rogers CSB - Lipos/Sarpos", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "NC Medicaid - Alliance Behavioral Health", "plan_name": "NC Medicaid - Alliance Behavioral Health", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "NC Medicaid - Healthy Blue", "plan_name": "NC Medicaid - Healthy Blue", "standard_charge_dollar": 895.63, "methodology": "fee schedule" }, { "payer_name": "NC Medicaid UHC Community", "plan_name": "NC Medicaid UHC Community", "standard_charge_dollar": 895.63, "methodology": "fee schedule" }, { "payer_name": "NC Wellcare Medicaid", "plan_name": "NC Wellcare Medicaid", "standard_charge_dollar": 895.63, "methodology": "fee schedule" }, { "payer_name": "New York UHC Medicaid", "plan_name": "New York UHC Medicaid", "standard_charge_dollar": 895.63, "methodology": "fee schedule" }, { "payer_name": "Ohio Medicaid - Buckeye Health Plan", "plan_name": "Ohio Medicaid - Buckeye Health Plan", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "PA Medicaid - Community Care", "plan_name": "PA Medicaid - Community Care", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "PAI", "plan_name": "PAI", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Paramount Advantage", "plan_name": "Paramount Advantage", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Premier Access, INC", "plan_name": "Premier Access, INC", "standard_charge_dollar": 1184.0, "methodology": "fee schedule" }, { "payer_name": "Priority Health", "plan_name": "Priority Health", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Selman Co", "plan_name": "Selman Co", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Seminole Tribal Health Plan", "plan_name": "Seminole Tribal Health Plan", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Sentara Commercial", "plan_name": "Sentara Commercial", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Sentara Medicare Advantange", "plan_name": "Sentara Medicare Advantange", "standard_charge_dollar": 621.81, "methodology": "fee schedule" }, { "payer_name": "Sentara VA Medicaid - Optima", "plan_name": "Sentara VA Medicaid - Optima", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "South Carolina Dept Health & Human Serv", "plan_name": "South Carolina Dept Health & Human Serv", "standard_charge_dollar": 360.0, "methodology": "fee schedule" }, { "payer_name": "Surest", "plan_name": "Surest", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "Symetra Commercial", "plan_name": "Symetra Commercial", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO BCBS Cover Kids", "plan_name": "TN MCO BCBS Cover Kids", "standard_charge_dollar": 630.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO Blue Care", "plan_name": "TN MCO Blue Care", "standard_charge_dollar": 710.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO BlueCare Plus", "plan_name": "TN MCO BlueCare Plus", "standard_charge_dollar": 630.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO UHC TN Dual SNP", "plan_name": "TN MCO UHC TN Dual SNP", "standard_charge_dollar": 607.24, "methodology": "fee schedule" }, { "payer_name": "TN MCO United Healthcare", "plan_name": "TN MCO United Healthcare", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO Wellpoint Medicaid", "plan_name": "TN MCO Wellpoint Medicaid", "standard_charge_dollar": 675.0, "methodology": "fee schedule" }, { "payer_name": "Tucker Administrators Inc", "plan_name": "Tucker Administrators Inc", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "UHC GEHA", "plan_name": "UHC GEHA", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "UHC Shared Services", "plan_name": "UHC Shared Services", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "UHC Student Resource Claims", "plan_name": "UHC Student Resource Claims", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "UMWA Health & Retirement Funds", "plan_name": "UMWA Health & Retirement Funds", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Unicare Healthcare Of WV", "plan_name": "Unicare Healthcare Of WV", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "United Behavioral Health Claims", "plan_name": "United Behavioral Health Claims", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Global", "plan_name": "United Healthcare Global", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "UPMC Health Plan", "plan_name": "UPMC Health Plan", "standard_charge_dollar": 1155.0, "methodology": "fee schedule" }, { "payer_name": "VA Aetna BH FIDE", "plan_name": "VA Aetna BH FIDE", "standard_charge_dollar": 1214.0, "methodology": "fee schedule" }, { "payer_name": "VA MCO Aetna Better Health", "plan_name": "VA MCO Aetna Better Health", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA MCO Anthem HealthKeepers Plus", "plan_name": "VA MCO Anthem HealthKeepers Plus", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA MCO Humana Medicaid", "plan_name": "VA MCO Humana Medicaid", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA MCO Premier", "plan_name": "VA MCO Premier", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA MCO Premier Elite Plus", "plan_name": "VA MCO Premier Elite Plus", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA MCO UnitedHealtcare Community Plan", "plan_name": "VA MCO UnitedHealtcare Community Plan", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA MCO Virgina Premier Medallion 4.0", "plan_name": "VA MCO Virgina Premier Medallion 4.0", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA Medicaid United Healthcare Plans", "plan_name": "VA Medicaid United Healthcare Plans", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA Molina Complete Care", "plan_name": "VA Molina Complete Care", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA United Healthcare Dual SNP", "plan_name": "VA United Healthcare Dual SNP", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Vaya Health", "plan_name": "Vaya Health", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Washington Medicaid - Amerigroup", "plan_name": "Washington Medicaid - Amerigroup", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Wellcare Medicare Advantage Plan", "plan_name": "Wellcare Medicare Advantage Plan", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "WPS", "plan_name": "WPS", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "WV Aetna Better Health", "plan_name": "WV Aetna Better Health", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "WV CHIPS/Molina Medicaid", "plan_name": "WV CHIPS/Molina Medicaid", "standard_charge_dollar": 650.0, "methodology": "fee schedule" } ], "gross_charge": 3000.0, "discounted_cash": 650.0, "minimum": 360.0, "maximum": 1960.0 } ] }, { "description": "Acute Psych Adol R&B", "code_information": [ { "code": "124", "type": "RC" }, { "code": "902", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Ohio Medicaid - UHC", "plan_name": "Ohio Medicaid - UHC", "standard_charge_dollar": 570.0, "methodology": "fee schedule" } ], "gross_charge": 3000.0, "minimum": 570.0, "maximum": 570.0 } ] }, { "description": "Acute Psych Adult R&B", "code_information": [ { "code": "124", "type": "RC" }, { "code": "901", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "90 Degree Benefits - MCA Administrators", "plan_name": "90 Degree Benefits - MCA Administrators", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "AARP United Healthcare Claim Division", "plan_name": "AARP United Healthcare Claim Division", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "ACS Benefits Serivces", "plan_name": "ACS Benefits Serivces", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Administrative Concepts", "plan_name": "Administrative Concepts", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 1306.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of KY", "plan_name": "Aetna Better Health Of KY", "standard_charge_dollar": 1030.91, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare PPO", "plan_name": "Aetna Medicare PPO", "standard_charge_dollar": 1214.0, "methodology": "fee schedule" }, { "payer_name": "All Savers", "plan_name": "All Savers", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "AllCare Health-Oregon Mediciad", "plan_name": "AllCare Health-Oregon Mediciad", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Allied Benefits", "plan_name": "Allied Benefits", "standard_charge_dollar": 1184.0, "methodology": "fee schedule" }, { "payer_name": "Ambetter", "plan_name": "Ambetter", "standard_charge_dollar": 880.0, "methodology": "fee schedule" }, { "payer_name": "American Behavioral", "plan_name": "American Behavioral", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Amerihealth - NC Medicaid", "plan_name": "Amerihealth - NC Medicaid", "standard_charge_dollar": 630.0, "methodology": "fee schedule" }, { "payer_name": "Amerihealth Caritas Louisiana", "plan_name": "Amerihealth Caritas Louisiana", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "ASR Health Benefits", "plan_name": "ASR Health Benefits", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HOME PLAN", "plan_name": "BCBS HOME PLAN", "standard_charge_dollar": 1020.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 1020.0, "methodology": "fee schedule" }, { "payer_name": "BCBS NC", "plan_name": "BCBS NC", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Virginia", "plan_name": "BCBS Virginia", "standard_charge_dollar": 1082.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options (Commerical)", "plan_name": "Beacon Health Options (Commerical)", "standard_charge_dollar": 1034.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Hlth Options Medicare", "plan_name": "Beacon Hlth Options Medicare", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Behavioral Health Systems", "plan_name": "Behavioral Health Systems", "standard_charge_dollar": 950.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Admin C/O Zelis", "plan_name": "Benefit Admin C/O Zelis", "standard_charge_dollar": 1000.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Administrative Services", "plan_name": "Benefit Administrative Services", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Bind Benefits", "plan_name": "Bind Benefits", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "Bluecare Plus Medicare", "plan_name": "Bluecare Plus Medicare", "standard_charge_dollar": 565.0, "methodology": "fee schedule" }, { "payer_name": "Boon Administrative Services", "plan_name": "Boon Administrative Services", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Bright Health Plan", "plan_name": "Bright Health Plan", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Bureau Of TennCare", "plan_name": "Bureau Of TennCare", "standard_charge_dollar": 570.65, "methodology": "fee schedule" }, { "payer_name": "Carelon", "plan_name": "Carelon", "standard_charge_dollar": 1082.0, "methodology": "fee schedule" }, { "payer_name": "Carelon Behavioral Health", "plan_name": "Carelon Behavioral Health", "standard_charge_dollar": 1034.0, "methodology": "fee schedule" }, { "payer_name": "Cigna", "plan_name": "Cigna", "standard_charge_dollar": 1118.0, "methodology": "fee schedule" }, { "payer_name": "Cigna/Allied Health/Oscar", "plan_name": "Cigna/Allied Health/Oscar", 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Medicaid - Wellpoint", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Kaiser Permanente Of GA - Commercial", "plan_name": "Kaiser Permanente Of GA - Commercial", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Kentucky Health Administrators", "plan_name": "Kentucky Health Administrators", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Kentucky Medicaid- Humana", "plan_name": "Kentucky Medicaid- Humana", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Keystone First - PA Medicaid BCBS", "plan_name": "Keystone First - PA Medicaid BCBS", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "KY Medicaid - Wellcare", "plan_name": "KY Medicaid - Wellcare", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "KY Medicaid Community Plan", "plan_name": "KY Medicaid Community Plan", 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"Wellcare Medicare Advantage Plan", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Dual Medicare Advantage Plan", "plan_name": "Wellpoint Dual Medicare Advantage Plan", "standard_charge_dollar": 675.0, "methodology": "fee schedule" }, { "payer_name": "WPS", "plan_name": "WPS", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "WV Aetna Better Health", "plan_name": "WV Aetna Better Health", "standard_charge_dollar": 650.0, "methodology": "fee schedule" } ], "gross_charge": 3000.0, "discounted_cash": 650.0, "minimum": 360.0, "maximum": 1400.0 } ] }, { "description": "Acute Psych Child R&B", "code_information": [ { "code": "124", "type": "RC" }, { "code": "703", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "90 Degree Benefits - MCA Administrators", "plan_name": "90 Degree Benefits - MCA Administrators", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "AARP United Healthcare Claim Division", "plan_name": "AARP United Healthcare Claim Division", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Administrative Concepts", "plan_name": "Administrative Concepts", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 1306.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of KY", "plan_name": "Aetna Better Health Of KY", "standard_charge_dollar": 1030.91, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare PPO", "plan_name": "Aetna Medicare PPO", "standard_charge_dollar": 1214.0, "methodology": "fee schedule" }, { "payer_name": "AllCare Health-Oregon Mediciad", "plan_name": "AllCare Health-Oregon Mediciad", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Allied Benefits", "plan_name": "Allied Benefits", "standard_charge_dollar": 1184.0, "methodology": "fee schedule" }, { "payer_name": "Ambetter", "plan_name": "Ambetter", "standard_charge_dollar": 880.0, "methodology": "fee schedule" }, { "payer_name": "American Behavioral", "plan_name": "American Behavioral", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Amerihealth - NC Medicaid", "plan_name": "Amerihealth - NC Medicaid", "standard_charge_dollar": 630.0, "methodology": "fee schedule" }, { "payer_name": "Amerihealth Caritas Louisiana", "plan_name": "Amerihealth Caritas Louisiana", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS Medciaid", "plan_name": "Anthem BCBS Medciaid", "standard_charge_dollar": 607.24, "methodology": "fee schedule" }, { "payer_name": "ASR Health Benefits", "plan_name": "ASR Health Benefits", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HOME PLAN", "plan_name": "BCBS HOME PLAN", "standard_charge_dollar": 1050.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "BCBS NC", "plan_name": "BCBS NC", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Virginia", "plan_name": "BCBS Virginia", "standard_charge_dollar": 1082.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options (Commerical)", "plan_name": "Beacon Health Options (Commerical)", "standard_charge_dollar": 1034.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Hlth Options Medicare", "plan_name": "Beacon Hlth Options Medicare", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Behavioral Health Systems", "plan_name": "Behavioral Health Systems", "standard_charge_dollar": 950.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Admin C/O Zelis", "plan_name": "Benefit Admin C/O Zelis", "standard_charge_dollar": 1000.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Administrative Services", "plan_name": "Benefit Administrative Services", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Bind Benefits", "plan_name": "Bind Benefits", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "Bluecare Plus Medicare", "plan_name": "Bluecare Plus Medicare", "standard_charge_dollar": 2350.0, "methodology": "fee schedule" }, { "payer_name": "Boon Administrative Services", "plan_name": "Boon Administrative Services", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Bright Health Plan", "plan_name": "Bright Health Plan", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Carelon", "plan_name": "Carelon", "standard_charge_dollar": 1082.0, "methodology": "fee schedule" }, { "payer_name": "Carelon Behavioral Health", "plan_name": "Carelon Behavioral Health", "standard_charge_dollar": 1034.0, "methodology": "fee schedule" }, { "payer_name": "Cigna", "plan_name": "Cigna", "standard_charge_dollar": 1118.0, "methodology": "fee schedule" }, { "payer_name": "Cigna/Allied Health/Oscar", "plan_name": "Cigna/Allied Health/Oscar", "standard_charge_dollar": 1155.0, "methodology": "fee schedule" }, { "payer_name": "Clear Chain", "plan_name": "Clear Chain", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Community Care Behavioral Health Medicai", "plan_name": "Community Care Behavioral Health Medicai", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "ComPsych", "plan_name": "ComPsych", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Eastman Chemical Company", "plan_name": "Eastman Chemical Company", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Evolution Healthcare", "plan_name": "Evolution Healthcare", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Farm Bureau Commerical Policy", "plan_name": "Farm Bureau Commerical Policy", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Fidelis Care", "plan_name": "Fidelis Care", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "GEHA", "plan_name": "GEHA", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "Global Choice KY Medicaid", "plan_name": "Global Choice KY Medicaid", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Golden Rule Ins Company", "plan_name": "Golden Rule Ins Company", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "Health Cost Solutions", "plan_name": "Health Cost Solutions", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Health Plans", 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"methodology": "fee schedule" }, { "payer_name": "VA MCO Virgina Premier Medallion 4.0", "plan_name": "VA MCO Virgina Premier Medallion 4.0", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA Medicaid United Healthcare Plans", "plan_name": "VA Medicaid United Healthcare Plans", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA Molina Complete Care", "plan_name": "VA Molina Complete Care", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA United Healthcare Dual SNP", "plan_name": "VA United Healthcare Dual SNP", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Vaya Health", "plan_name": "Vaya Health", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Washington Medicaid - Amerigroup", "plan_name": "Washington Medicaid - Amerigroup", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Wellcare Medicare Advantage Plan", "plan_name": "Wellcare Medicare Advantage Plan", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Dual Medicare Advantage Plan", "plan_name": "Wellpoint Dual Medicare Advantage Plan", "standard_charge_dollar": 675.0, "methodology": "fee schedule" }, { "payer_name": "WPS", "plan_name": "WPS", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "WV Aetna Better Health", "plan_name": "WV Aetna Better Health", "standard_charge_dollar": 650.0, "methodology": "fee schedule" } ], "gross_charge": 3000.0, "discounted_cash": 650.0, "minimum": 360.0, "maximum": 2350.0 } ] }, { "description": "Acute Psych Gero R&B", "code_information": [ { "code": "124", "type": "RC" }, { "code": "900", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "90 Degree Benefits - MCA Administrators", "plan_name": "90 Degree Benefits - MCA 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"methodology": "fee schedule" }, { "payer_name": "VA MCO Virgina Premier Medallion 4.0", "plan_name": "VA MCO Virgina Premier Medallion 4.0", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA Medicaid United Healthcare Plans", "plan_name": "VA Medicaid United Healthcare Plans", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA Molina Complete Care", "plan_name": "VA Molina Complete Care", "standard_charge_dollar": 629.27, "methodology": "fee schedule" }, { "payer_name": "VA United Healthcare Dual SNP", "plan_name": "VA United Healthcare Dual SNP", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Vaya Health", "plan_name": "Vaya Health", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Washington Medicaid - Amerigroup", "plan_name": "Washington Medicaid - Amerigroup", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Wellcare Medicare Advantage Plan", "plan_name": "Wellcare Medicare Advantage Plan", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Dual Medicare Advantage Plan", "plan_name": "Wellpoint Dual Medicare Advantage Plan", "standard_charge_dollar": 675.0, "methodology": "fee schedule" }, { "payer_name": "WPS", "plan_name": "WPS", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "WV Aetna Better Health", "plan_name": "WV Aetna Better Health", "standard_charge_dollar": 650.0, "methodology": "fee schedule" } ], "gross_charge": 3000.0, "discounted_cash": 650.0, "minimum": 500.0, "maximum": 1306.0 } ] }, { "description": "Acute CD Adol R&B", "code_information": [ { "code": "126", "type": "RC" }, { "code": "706", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "90 Degree Benefits - MCA Administrators", "plan_name": "90 Degree Benefits - MCA 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Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "BCBS NC", "plan_name": "BCBS NC", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Virginia", "plan_name": "BCBS Virginia", "standard_charge_dollar": 1029.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options (Commerical)", "plan_name": "Beacon Health Options (Commerical)", "standard_charge_dollar": 1034.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Hlth Options Medicare", "plan_name": "Beacon Hlth Options Medicare", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Admin C/O Zelis", "plan_name": "Benefit Admin C/O Zelis", "standard_charge_dollar": 1000.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Administrative Services", "plan_name": "Benefit Administrative Services", "standard_charge_dollar": 800.0, "methodology": "fee 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"methodology": "fee schedule" }, { "payer_name": "VA Medicaid United Healthcare Plans", "plan_name": "VA Medicaid United Healthcare Plans", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA Molina Complete Care", "plan_name": "VA Molina Complete Care", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA United Healthcare Dual SNP", "plan_name": "VA United Healthcare Dual SNP", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Vaya Health", "plan_name": "Vaya Health", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Washington Medicaid - Amerigroup", "plan_name": "Washington Medicaid - Amerigroup", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Wellcare Medicare Advantage Plan", "plan_name": "Wellcare Medicare Advantage Plan", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Dual Medicare Advantage Plan", "plan_name": "Wellpoint Dual Medicare Advantage Plan", "standard_charge_dollar": 675.0, "methodology": "fee schedule" }, { "payer_name": "WPS", "plan_name": "WPS", "standard_charge_dollar": 700.0, "methodology": "fee schedule" } ], "gross_charge": 3000.0, "discounted_cash": 650.0, "minimum": 360.0, "maximum": 1960.0 } ] }, { "description": "Acute CD Adult R&B", "code_information": [ { "code": "126", "type": "RC" }, { "code": "705", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "90 Degree Benefits - MCA Administrators", "plan_name": "90 Degree Benefits - MCA Administrators", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "AARP United Healthcare Claim Division", "plan_name": "AARP United Healthcare Claim Division", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Administrative Concepts", "plan_name": "Administrative Concepts", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 1075.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of KY", "plan_name": "Aetna Better Health Of KY", "standard_charge_dollar": 1030.91, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare PPO", "plan_name": "Aetna Medicare PPO", "standard_charge_dollar": 950.0, "methodology": "fee schedule" }, { "payer_name": "AllCare Health-Oregon Mediciad", "plan_name": "AllCare Health-Oregon Mediciad", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Allied Benefits", "plan_name": "Allied Benefits", "standard_charge_dollar": 1184.0, "methodology": "fee schedule" }, { "payer_name": "Ambetter", "plan_name": "Ambetter", "standard_charge_dollar": 880.0, "methodology": "fee schedule" }, { "payer_name": "American Behavioral", "plan_name": "American Behavioral", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Amerihealth - NC Medicaid", "plan_name": "Amerihealth - NC Medicaid", "standard_charge_dollar": 630.0, "methodology": "fee schedule" }, { "payer_name": "Amerihealth Caritas Louisiana", "plan_name": "Amerihealth Caritas Louisiana", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "ASR Health Benefits", "plan_name": "ASR Health Benefits", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HOME PLAN", "plan_name": "BCBS HOME PLAN", "standard_charge_dollar": 1020.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 1020.0, "methodology": "fee schedule" }, { "payer_name": "BCBS NC", "plan_name": "BCBS NC", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Virginia", "plan_name": "BCBS Virginia", "standard_charge_dollar": 1029.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options (Commerical)", "plan_name": "Beacon Health Options (Commerical)", "standard_charge_dollar": 1034.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Hlth Options Medicare", "plan_name": "Beacon Hlth Options Medicare", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Admin C/O Zelis", "plan_name": "Benefit Admin C/O Zelis", "standard_charge_dollar": 1000.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Administrative Services", "plan_name": "Benefit Administrative Services", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Bind Benefits", "plan_name": "Bind Benefits", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "Bluecare Plus Medicare", "plan_name": "Bluecare Plus Medicare", "standard_charge_dollar": 565.0, "methodology": "fee schedule" }, { "payer_name": "Boon Administrative Services", "plan_name": "Boon Administrative Services", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Bright Health Plan", "plan_name": "Bright Health Plan", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Bureau Of TennCare", "plan_name": "Bureau Of TennCare", "standard_charge_dollar": 570.65, "methodology": "fee schedule" }, { "payer_name": "Carelon", "plan_name": "Carelon", "standard_charge_dollar": 1082.0, "methodology": "fee schedule" }, { "payer_name": "Carelon Behavioral Health", "plan_name": "Carelon Behavioral Health", "standard_charge_dollar": 1034.0, "methodology": "fee schedule" }, { "payer_name": "Cigna", "plan_name": "Cigna", "standard_charge_dollar": 1118.0, "methodology": "fee schedule" }, { "payer_name": "Cigna/Allied Health/Oscar", "plan_name": "Cigna/Allied Health/Oscar", "standard_charge_dollar": 950.0, "methodology": "fee schedule" }, { "payer_name": "Clear Chain", "plan_name": "Clear Chain", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Community Care Behavioral Health Medicai", "plan_name": "Community Care Behavioral Health Medicai", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "ComPsych", "plan_name": "ComPsych", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Eastman Chemical Company", "plan_name": "Eastman Chemical Company", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Evolution Healthcare", "plan_name": "Evolution Healthcare", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Farm Bureau Commerical Policy", "plan_name": "Farm Bureau Commerical Policy", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Fidelis Care", "plan_name": "Fidelis Care", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "GEHA", "plan_name": "GEHA", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "Global Choice KY Medicaid", "plan_name": "Global Choice KY Medicaid", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Golden Rule Ins Company", "plan_name": "Golden Rule Ins Company", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "Health Cost Solutions", "plan_name": "Health Cost Solutions", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Health Plans", "plan_name": "Health Plans", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Health Smart", "plan_name": "Health Smart", "standard_charge_dollar": 1300.0, "methodology": "fee schedule" }, { "payer_name": "Healthcomp", "plan_name": "Healthcomp", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Healthscope", "plan_name": "Healthscope", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Highlands CSB - Lipos/Sarpos", "plan_name": "Highlands CSB - Lipos/Sarpos", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Humana - Commerical", "plan_name": "Humana - Commerical", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Idaho Medicaid - Optum", "plan_name": "Idaho Medicaid - Optum", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Illinois Meridian Medicaid", "plan_name": "Illinois Meridian Medicaid", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Imagine 360/Group & Pension Admin", "plan_name": "Imagine 360/Group & Pension Admin", "standard_charge_dollar": 800.64, "methodology": "fee schedule" }, { "payer_name": "Indiana Medicaid - Anthem BCBS", "plan_name": "Indiana Medicaid - Anthem BCBS", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Iowa Medicaid - Wellpoint", "plan_name": "Iowa Medicaid - Wellpoint", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Kaiser Permanente Of GA - Commercial", "plan_name": "Kaiser Permanente Of GA - Commercial", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Kentucky Health Administrators", "plan_name": "Kentucky Health Administrators", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Kentucky Medicaid- Humana", "plan_name": "Kentucky Medicaid- Humana", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Keystone First - PA Medicaid BCBS", "plan_name": "Keystone First - PA Medicaid BCBS", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "KY Medicaid - Wellcare", "plan_name": "KY Medicaid - Wellcare", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "KY Medicaid Community Plan", "plan_name": "KY Medicaid Community Plan", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "LA UHC Medicaid", "plan_name": "LA UHC Medicaid", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Lineco", "plan_name": "Lineco", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Louisiana Healthcare Connections", "plan_name": "Louisiana Healthcare Connections", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Lucent Health", "plan_name": "Lucent Health", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Magellan Healthcare Commerical Plan", "plan_name": "Magellan Healthcare Commerical Plan", "standard_charge_dollar": 1051.0, "methodology": "fee schedule" }, { "payer_name": "Magnacare", "plan_name": "Magnacare", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Medcost Benefit Services", "plan_name": "Medcost Benefit Services", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Medi-Share", "plan_name": "Medi-Share", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Medica Behavioral Health", "plan_name": "Medica Behavioral Health", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Meritain Health", "plan_name": "Meritain Health", "standard_charge_dollar": 950.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare Of NY Medicaid", "plan_name": "Molina Healthcare Of NY Medicaid", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Molina Of Michigan", "plan_name": "Molina Of Michigan", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Mount Rogers CSB - Lipos/Sarpos", "plan_name": "Mount Rogers CSB - Lipos/Sarpos", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": 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Medicaid - UHC", "standard_charge_dollar": 570.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "PA Medicaid - Community Care", "plan_name": "PA Medicaid - Community Care", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "PAI", "plan_name": "PAI", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Paramount Advantage", "plan_name": "Paramount Advantage", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Premier Access, INC", "plan_name": "Premier Access, INC", "standard_charge_dollar": 974.0, "methodology": "fee schedule" }, { "payer_name": "Priority Health", "plan_name": "Priority Health", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Selman Co", "plan_name": "Selman Co", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Seminole Tribal Health Plan", "plan_name": "Seminole Tribal Health Plan", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Sentara Commercial", "plan_name": "Sentara Commercial", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Sentara Medicare Advantange", "plan_name": "Sentara Medicare Advantange", "standard_charge_dollar": 621.81, "methodology": "fee schedule" }, { "payer_name": "Sentara VA Medicaid - Optima", "plan_name": "Sentara VA Medicaid - Optima", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "South Carolina Dept Health & Human Serv", "plan_name": "South Carolina Dept Health & Human Serv", "standard_charge_dollar": 360.0, "methodology": "fee schedule" }, { "payer_name": "Surest", "plan_name": "Surest", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "Symetra Commercial", "plan_name": "Symetra Commercial", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO BCBS Cover Kids", "plan_name": "TN MCO BCBS Cover Kids", "standard_charge_dollar": 620.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO Blue Care", "plan_name": "TN MCO Blue Care", "standard_charge_dollar": 710.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO BlueCare Plus", "plan_name": "TN MCO BlueCare Plus", "standard_charge_dollar": 620.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO UHC TN Dual SNP", "plan_name": "TN MCO UHC TN Dual SNP", "standard_charge_dollar": 607.24, "methodology": "fee schedule" }, { "payer_name": "TN MCO United Healthcare", "plan_name": "TN MCO United Healthcare", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO Wellpoint Medicaid", "plan_name": "TN MCO Wellpoint 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650.0, "methodology": "fee schedule" }, { "payer_name": "Unicare Healthcare Of WV", "plan_name": "Unicare Healthcare Of WV", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "United Behavioral Health Claims", "plan_name": "United Behavioral Health Claims", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "UPMC Health Plan", "plan_name": "UPMC Health Plan", "standard_charge_dollar": 950.0, "methodology": "fee schedule" }, { "payer_name": "VA Aetna BH FIDE", "plan_name": "VA Aetna BH FIDE", "standard_charge_dollar": 950.0, "methodology": "fee schedule" }, { "payer_name": "VA MCO Aetna Better Health", "plan_name": "VA MCO Aetna Better Health", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA MCO Anthem HealthKeepers Plus", "plan_name": "VA MCO Anthem HealthKeepers Plus", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA MCO Humana Medicaid", "plan_name": "VA MCO Humana Medicaid", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA MCO Premier", "plan_name": "VA MCO Premier", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA MCO Premier Elite Plus", "plan_name": "VA MCO Premier Elite Plus", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA MCO UnitedHealtcare Community Plan", "plan_name": "VA MCO UnitedHealtcare Community Plan", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA MCO Virgina Premier Medallion 4.0", "plan_name": "VA MCO Virgina Premier Medallion 4.0", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA Medicaid United Healthcare Plans", "plan_name": "VA Medicaid United Healthcare Plans", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA Molina Complete Care", "plan_name": "VA Molina Complete Care", "standard_charge_dollar": 1074.11, "methodology": "fee schedule" }, { "payer_name": "VA United Healthcare Dual SNP", "plan_name": "VA United Healthcare Dual SNP", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Vaya Health", "plan_name": "Vaya Health", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Washington Medicaid - Amerigroup", "plan_name": "Washington Medicaid - Amerigroup", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Wellcare Medicare Advantage Plan", "plan_name": "Wellcare Medicare Advantage Plan", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Dual Medicare Advantage Plan", "plan_name": "Wellpoint Dual Medicare Advantage Plan", "standard_charge_dollar": 675.0, "methodology": "fee schedule" }, { "payer_name": "WPS", "plan_name": "WPS", "standard_charge_dollar": 700.0, "methodology": "fee schedule" } ], "gross_charge": 3000.0, "discounted_cash": 650.0, "minimum": 360.0, "maximum": 1300.0 } ] }, { "description": "Acute CD Gero R&B", "code_information": [ { "code": "126", "type": "RC" }, { "code": "704", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "90 Degree Benefits - MCA Administrators", "plan_name": "90 Degree Benefits - MCA Administrators", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "AARP United Healthcare Claim Division", "plan_name": "AARP United Healthcare Claim Division", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Administrative Concepts", "plan_name": "Administrative Concepts", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 1075.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of KY", "plan_name": "Aetna Better Health Of KY", "standard_charge_dollar": 1030.91, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare PPO", "plan_name": "Aetna Medicare PPO", "standard_charge_dollar": 950.0, "methodology": "fee schedule" }, { "payer_name": "AllCare Health-Oregon Mediciad", "plan_name": "AllCare Health-Oregon Mediciad", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Allied Benefits", "plan_name": "Allied Benefits", "standard_charge_dollar": 1184.0, "methodology": "fee schedule" }, { "payer_name": "Ambetter", "plan_name": "Ambetter", "standard_charge_dollar": 880.0, "methodology": "fee schedule" }, { "payer_name": "American Behavioral", "plan_name": "American Behavioral", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Amerihealth - NC Medicaid", "plan_name": "Amerihealth - NC Medicaid", "standard_charge_dollar": 630.0, "methodology": "fee schedule" }, { "payer_name": "Amerihealth Caritas Louisiana", "plan_name": "Amerihealth Caritas Louisiana", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "ASR Health Benefits", "plan_name": "ASR Health Benefits", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HOME PLAN", "plan_name": "BCBS HOME PLAN", "standard_charge_dollar": 1020.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 1020.0, "methodology": "fee schedule" }, { "payer_name": "BCBS NC", "plan_name": "BCBS NC", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Virginia", "plan_name": "BCBS Virginia", "standard_charge_dollar": 1029.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options (Commerical)", "plan_name": "Beacon Health Options (Commerical)", "standard_charge_dollar": 1034.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Hlth Options Medicare", "plan_name": "Beacon Hlth Options Medicare", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Admin C/O Zelis", "plan_name": "Benefit Admin C/O Zelis", "standard_charge_dollar": 1000.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Administrative Services", "plan_name": "Benefit Administrative Services", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Bind Benefits", "plan_name": "Bind Benefits", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "Bluecare Plus Medicare", "plan_name": "Bluecare Plus Medicare", "standard_charge_dollar": 565.0, "methodology": "fee schedule" }, { "payer_name": "Boon Administrative Services", "plan_name": "Boon Administrative Services", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Bright Health Plan", "plan_name": "Bright Health Plan", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": 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"payer_name": "UHC Medicare Advantage", "plan_name": "UHC Medicare Advantage", "standard_charge_dollar": 180.0, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "discounted_cash": 175.0, "minimum": 180.0, "maximum": 180.0 } ] }, { "description": "Adol CD IOP 3 hrs", "code_information": [ { "code": "H0015", "type": "HCPCS" }, { "code": "971", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "90 Degree Benefits - MCA Administrators", "plan_name": "90 Degree Benefits - MCA Administrators", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "AARP United Healthcare Claim Division", "plan_name": "AARP United Healthcare Claim Division", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "Administrative Concepts", "plan_name": "Administrative Concepts", "standard_charge_dollar": 150.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": 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"standard_charge_dollar": 235.0, "methodology": "fee schedule" }, { "payer_name": "Aither Health", "plan_name": "Aither Health", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "All Savers", "plan_name": "All Savers", "standard_charge_dollar": 180.0, "methodology": "fee schedule" }, { "payer_name": "Ambetter", "plan_name": "Ambetter", "standard_charge_dollar": 185.0, "methodology": "fee schedule" }, { "payer_name": "American Behavioral", "plan_name": "American Behavioral", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HOME PLAN", "plan_name": "BCBS HOME PLAN", "standard_charge_dollar": 260.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Virginia", "plan_name": "BCBS Virginia", "standard_charge_dollar": 196.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options (Commerical)", "plan_name": "Beacon Health Options (Commerical)", "standard_charge_dollar": 234.0, "methodology": "fee schedule" }, { "payer_name": "Bluecare Plus Medicare", "plan_name": "Bluecare Plus Medicare", "standard_charge_dollar": 150.0, "methodology": "fee schedule" }, { "payer_name": "Bright Health Plan", "plan_name": "Bright Health Plan", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "Carelon", "plan_name": "Carelon", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "Carelon Behavioral Health", "plan_name": "Carelon Behavioral Health", "standard_charge_dollar": 234.0, "methodology": "fee schedule" }, { "payer_name": "Cigna", "plan_name": "Cigna", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "Cigna/Allied Health/Oscar", "plan_name": "Cigna/Allied Health/Oscar", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "ComPsych", "plan_name": "ComPsych", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "Health Cost Solutions", "plan_name": "Health Cost Solutions", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "Healthcomp", "plan_name": "Healthcomp", "standard_charge_dollar": 150.0, "methodology": "fee schedule" }, { "payer_name": "Humana - Commerical", "plan_name": "Humana - Commerical", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Humana Medicare Advantage Plan", "plan_name": "Humana Medicare Advantage Plan", "standard_charge_dollar": 69.26, "methodology": "fee schedule" }, { "payer_name": "Magellan Healthcare Commerical Plan", "plan_name": "Magellan Healthcare Commerical Plan", "standard_charge_dollar": 239.0, "methodology": "fee schedule" }, { "payer_name": "Medcost Benefit Services", "plan_name": "Medcost Benefit Services", "standard_charge_dollar": 325.0, "methodology": "fee 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"plan_name": "Sentara VA Medicaid - Optima", "standard_charge_dollar": 266.25, "methodology": "fee schedule" }, { "payer_name": "TN MCO BCBS Cover Kids", "plan_name": "TN MCO BCBS Cover Kids", "standard_charge_dollar": 160.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO Blue Care", "plan_name": "TN MCO Blue Care", "standard_charge_dollar": 170.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO BlueCare Plus", "plan_name": "TN MCO BlueCare Plus", "standard_charge_dollar": 160.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO UHC TN Dual SNP", "plan_name": "TN MCO UHC TN Dual SNP", "standard_charge_dollar": 180.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO United Healthcare", "plan_name": "TN MCO United Healthcare", "standard_charge_dollar": 165.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO Wellpoint Medicaid", "plan_name": "TN MCO Wellpoint Medicaid", "standard_charge_dollar": 150.0, "methodology": "fee schedule" }, { "payer_name": "UHC GEHA", "plan_name": "UHC GEHA", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "UHC Medicare Advantage", "plan_name": "UHC Medicare Advantage", "standard_charge_dollar": 180.0, "methodology": "fee schedule" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 180.0, "methodology": "fee schedule" }, { "payer_name": "United Behavioral Health Claims", "plan_name": "United Behavioral Health Claims", "standard_charge_dollar": 180.0, "methodology": "fee schedule" }, { "payer_name": "UPMC Health Plan", "plan_name": "UPMC Health Plan", "standard_charge_dollar": 235.0, "methodology": "fee schedule" }, { "payer_name": "VA Aetna BH FIDE", "plan_name": "VA Aetna BH FIDE", "standard_charge_dollar": 235.0, "methodology": "fee schedule" }, { "payer_name": "VA MCO Aetna Better Health", "plan_name": "VA MCO Aetna Better Health", "standard_charge_dollar": 170.0, "methodology": "fee schedule" }, { "payer_name": "VA MCO Anthem HealthKeepers Plus", "plan_name": "VA MCO Anthem HealthKeepers Plus", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "VA MCO UnitedHealtcare Community Plan", "plan_name": "VA MCO UnitedHealtcare Community Plan", "standard_charge_dollar": 141.51, "methodology": "fee schedule" }, { "payer_name": "VA MCO Virgina Premier Medallion 4.0", "plan_name": "VA MCO Virgina Premier Medallion 4.0", "standard_charge_dollar": 170.0, "methodology": "fee schedule" }, { "payer_name": "VA Molina Complete Care", "plan_name": "VA Molina Complete Care", "standard_charge_dollar": 215.0, "methodology": "fee schedule" }, { "payer_name": "VA United Healthcare Dual SNP", "plan_name": "VA United Healthcare Dual SNP", "standard_charge_dollar": 69.56, "methodology": "fee schedule" }, { "payer_name": "Wellcare Medicare Advantage Plan", "plan_name": "Wellcare Medicare Advantage Plan", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Dual Medicare Advantage Plan", "plan_name": "Wellpoint Dual Medicare Advantage Plan", "standard_charge_dollar": 150.0, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "discounted_cash": 175.0, "minimum": 69.26, "maximum": 325.0 } ] }, { "description": "Gero CD IOP 3 hrs", "code_information": [ { "code": "H0015", "type": "HCPCS" }, { "code": "756", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "90 Degree Benefits - MCA Administrators", "plan_name": "90 Degree Benefits - MCA Administrators", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "AARP United Healthcare Claim Division", "plan_name": "AARP United Healthcare Claim Division", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "Administrative Concepts", "plan_name": "Administrative Concepts", "standard_charge_dollar": 150.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": 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HealthKeepers Plus", "plan_name": "VA MCO Anthem HealthKeepers Plus", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "VA MCO UnitedHealtcare Community Plan", "plan_name": "VA MCO UnitedHealtcare Community Plan", "standard_charge_dollar": 141.51, "methodology": "fee schedule" }, { "payer_name": "VA Molina Complete Care", "plan_name": "VA Molina Complete Care", "standard_charge_dollar": 215.0, "methodology": "fee schedule" }, { "payer_name": "VA United Healthcare Dual SNP", "plan_name": "VA United Healthcare Dual SNP", "standard_charge_dollar": 69.56, "methodology": "fee schedule" }, { "payer_name": "Wellcare Medicare Advantage Plan", "plan_name": "Wellcare Medicare Advantage Plan", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Dual Medicare Advantage Plan", "plan_name": "Wellpoint Dual Medicare Advantage Plan", "standard_charge_dollar": 150.0, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "discounted_cash": 175.0, "minimum": 69.26, "maximum": 325.0 } ] }, { "description": "Telehealth Adol CD IOP 3 hrs", "code_information": [ { "code": "H0015", "type": "HCPCS" }, { "code": "810", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS HOME PLAN", "plan_name": "BCBS HOME PLAN", "standard_charge_dollar": 260.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Virginia", "plan_name": "BCBS Virginia", "standard_charge_dollar": 164.0, "methodology": "fee schedule" }, { "payer_name": "Cigna", "plan_name": "Cigna", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "Golden Rule Ins Company", "plan_name": "Golden Rule Ins Company", "standard_charge_dollar": 180.0, "methodology": "fee schedule" }, { "payer_name": "Humana - Commerical", "plan_name": "Humana - Commerical", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Humana Medicare Advantage Plan", 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"standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UHC Medicare Advantage", "plan_name": "UHC Medicare Advantage", "standard_charge_dollar": 21.76, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "discounted_cash": 175.0, "minimum": 21.76, "maximum": 21.76 } ] }, { "description": "Tri/Medi CD Adult IOP-2 unit", "code_information": [ { "code": "H0015", "type": "HCPCS" }, { "code": "768", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UHC Medicare Advantage", "plan_name": "UHC Medicare Advantage", "standard_charge_dollar": 43.52, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "discounted_cash": 175.0, "minimum": 43.52, "maximum": 43.52 } ] }, { "description": "Tri/Medi CD Adult IOP-3 unit", "code_information": [ { "code": "H0015", "type": "HCPCS" }, { "code": "769", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { 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"standard_charge_dollar": 43.52, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "discounted_cash": 175.0, "minimum": 43.52, "maximum": 43.52 } ] }, { "description": "Tri/Medi CD Gero IOP-3 unit", "code_information": [ { "code": "H0015", "type": "HCPCS" }, { "code": "759", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UHC Medicare Advantage", "plan_name": "UHC Medicare Advantage", "standard_charge_dollar": 65.28, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "discounted_cash": 175.0, "minimum": 65.28, "maximum": 65.28 } ] }, { "description": "Rehab Gero R&B", "code_information": [ { "code": "907", "type": "RC" }, { "code": "907", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Ohio Medicaid - UHC", "plan_name": "Ohio Medicaid - UHC", "standard_charge_dollar": 570.0, "methodology": "fee schedule" } ], "discounted_cash": 650.0, "minimum": 570.0, "maximum": 570.0 } ] }, { "description": "Rehab Adult R&B", "code_information": [ { "code": "908", "type": "RC" }, { "code": "908", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Ohio Medicaid - UHC", "plan_name": "Ohio Medicaid - UHC", "standard_charge_dollar": 570.0, "methodology": "fee schedule" } ], "discounted_cash": 650.0, "minimum": 570.0, "maximum": 570.0 } ] }, { "description": "PHP CD ADOL", "code_information": [ { "code": "H0035", "type": "HCPCS" }, { "code": "70013", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS HOME PLAN", "plan_name": "BCBS HOME PLAN", "standard_charge_dollar": 420.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO Blue Care", "plan_name": "TN MCO Blue Care", "standard_charge_dollar": 260.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO United Healthcare", "plan_name": "TN MCO United Healthcare", "standard_charge_dollar": 300.0, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 325.0, "minimum": 260.0, "maximum": 420.0 } ] }, { "description": "PHP CD Adult Daily", "code_information": [ { "code": "H0035", "type": "HCPCS" }, { "code": "733", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "90 Degree Benefits - MCA Administrators", "plan_name": "90 Degree Benefits - MCA Administrators", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "AARP United Healthcare Claim Division", "plan_name": "AARP United Healthcare Claim Division", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Administrative Concepts", "plan_name": "Administrative Concepts", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 572.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare PPO", "plan_name": "Aetna Medicare PPO", "standard_charge_dollar": 505.0, "methodology": "fee schedule" }, { "payer_name": "Altrua Healthshare", "plan_name": "Altrua Healthshare", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Ambetter", "plan_name": "Ambetter", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "American Behavioral", "plan_name": "American Behavioral", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HOME PLAN", "plan_name": "BCBS HOME PLAN", "standard_charge_dollar": 420.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 420.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Virginia", "plan_name": "BCBS Virginia", "standard_charge_dollar": 401.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options (Commerical)", "plan_name": "Beacon Health Options (Commerical)", "standard_charge_dollar": 419.0, "methodology": "fee schedule" }, { "payer_name": "Bluecare Plus Medicare", "plan_name": "Bluecare Plus Medicare", "standard_charge_dollar": 205.0, "methodology": "fee schedule" }, { "payer_name": "Bright Health Plan", "plan_name": "Bright Health Plan", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Carelon", "plan_name": "Carelon", "standard_charge_dollar": 360.0, "methodology": "fee schedule" }, { "payer_name": "Carelon Behavioral Health", "plan_name": "Carelon Behavioral Health", "standard_charge_dollar": 419.0, "methodology": "fee schedule" }, { "payer_name": "Cigna", "plan_name": "Cigna", "standard_charge_dollar": 432.0, "methodology": "fee schedule" }, { "payer_name": "Cigna/Allied Health/Oscar", "plan_name": "Cigna/Allied Health/Oscar", "standard_charge_dollar": 400.0, "methodology": "fee schedule" }, { "payer_name": "ComPsych", "plan_name": "ComPsych", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Health Cost Solutions", "plan_name": "Health Cost Solutions", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Healthcomp", "plan_name": "Healthcomp", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "Humana - Commerical", "plan_name": "Humana - Commerical", "standard_charge_dollar": 485.0, "methodology": "fee schedule" }, { "payer_name": "Humana Medicare Advantage Plan", "plan_name": "Humana Medicare Advantage Plan", "standard_charge_dollar": 230.09, "methodology": "fee schedule" }, { "payer_name": "Magellan Healthcare Commerical Plan", "plan_name": "Magellan Healthcare Commerical Plan", "standard_charge_dollar": 456.0, "methodology": "fee schedule" }, { "payer_name": "Medcost Benefit Services", "plan_name": "Medcost Benefit Services", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Meritain Health", "plan_name": "Meritain Health", "standard_charge_dollar": 518.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "PAI", "plan_name": "PAI", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Premier Access, INC", "plan_name": "Premier Access, INC", "standard_charge_dollar": 518.0, "methodology": "fee schedule" }, { "payer_name": "Selman Co", "plan_name": "Selman Co", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "Sentara Commercial", "plan_name": "Sentara Commercial", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "Sentara Medicare Advantange", "plan_name": "Sentara Medicare Advantange", "standard_charge_dollar": 315.0, "methodology": "fee schedule" }, { "payer_name": "Sentara VA Medicaid - Optima", "plan_name": "Sentara VA Medicaid - Optima", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO BCBS Cover Kids", "plan_name": "TN MCO BCBS Cover Kids", "standard_charge_dollar": 228.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO Blue Care", "plan_name": "TN MCO Blue Care", "standard_charge_dollar": 260.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO BlueCare Plus", "plan_name": "TN MCO BlueCare Plus", "standard_charge_dollar": 228.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO UHC TN Dual SNP", "plan_name": "TN MCO UHC TN Dual SNP", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO United Healthcare", "plan_name": "TN MCO United Healthcare", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO Wellpoint Medicaid", "plan_name": "TN MCO Wellpoint Medicaid", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "UHC GEHA", "plan_name": "UHC GEHA", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "UHC Medicare Advantage", "plan_name": "UHC Medicare Advantage", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "United Behavioral Health Claims", "plan_name": "United Behavioral Health Claims", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "UPMC Health Plan", "plan_name": "UPMC Health Plan", "standard_charge_dollar": 505.0, "methodology": "fee schedule" }, { "payer_name": "VA Aetna BH FIDE", "plan_name": "VA Aetna BH FIDE", "standard_charge_dollar": 505.0, "methodology": "fee schedule" }, { "payer_name": "VA MCO Aetna Better Health", "plan_name": "VA MCO Aetna Better Health", "standard_charge_dollar": 315.0, "methodology": "fee schedule" }, { "payer_name": "VA MCO Anthem HealthKeepers Plus", "plan_name": "VA MCO Anthem HealthKeepers Plus", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "VA MCO Premier Elite Plus", "plan_name": "VA MCO Premier Elite Plus", "standard_charge_dollar": 315.0, "methodology": "fee schedule" }, { "payer_name": "VA MCO UnitedHealtcare Community Plan", "plan_name": "VA MCO UnitedHealtcare Community Plan", "standard_charge_dollar": 222.76, "methodology": "fee schedule" }, { "payer_name": "VA MCO Virgina Premier Medallion 4.0", "plan_name": "VA MCO Virgina Premier Medallion 4.0", "standard_charge_dollar": 315.0, "methodology": "fee schedule" }, { "payer_name": "VA Molina Complete Care", "plan_name": "VA Molina Complete Care", "standard_charge_dollar": 315.0, "methodology": "fee schedule" }, { "payer_name": "VA United Healthcare Dual SNP", "plan_name": "VA United Healthcare Dual SNP", "standard_charge_dollar": 109.59, "methodology": "fee schedule" }, { "payer_name": "Wellcare Medicare Advantage Plan", "plan_name": "Wellcare Medicare Advantage Plan", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Dual Medicare Advantage Plan", "plan_name": "Wellpoint Dual Medicare Advantage Plan", "standard_charge_dollar": 300.0, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 325.0, "minimum": 109.59, "maximum": 572.0 } ] }, { "description": "PHP CD Child/Adol Daily", "code_information": [ { "code": "H0035", "type": "HCPCS" }, { "code": "745", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "90 Degree Benefits - MCA Administrators", "plan_name": "90 Degree Benefits - MCA Administrators", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Administrative Concepts", "plan_name": "Administrative Concepts", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 572.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare PPO", "plan_name": "Aetna Medicare PPO", "standard_charge_dollar": 505.0, "methodology": "fee schedule" }, { "payer_name": "Altrua Healthshare", "plan_name": "Altrua Healthshare", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Ambetter", "plan_name": "Ambetter", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "American Behavioral", "plan_name": "American Behavioral", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HOME PLAN", "plan_name": "BCBS HOME PLAN", "standard_charge_dollar": 420.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Virginia", "plan_name": "BCBS Virginia", "standard_charge_dollar": 336.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options (Commerical)", "plan_name": "Beacon Health Options (Commerical)", "standard_charge_dollar": 419.0, "methodology": "fee schedule" }, { "payer_name": "Bright Health 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"standard_charge_dollar": 518.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "PAI", "plan_name": "PAI", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Premier Access, INC", "plan_name": "Premier Access, INC", "standard_charge_dollar": 518.0, "methodology": "fee schedule" }, { "payer_name": "Selman Co", "plan_name": "Selman Co", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "Sentara Commercial", "plan_name": "Sentara Commercial", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "Sentara Medicare Advantange", "plan_name": "Sentara Medicare Advantange", "standard_charge_dollar": 315.0, "methodology": "fee schedule" }, { "payer_name": "Sentara VA Medicaid - Optima", "plan_name": "Sentara VA Medicaid - Optima", "standard_charge_dollar": 500.0, "methodology": "fee 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"methodology": "fee schedule" }, { "payer_name": "Humana Medicare Advantage Plan", "plan_name": "Humana Medicare Advantage Plan", "standard_charge_dollar": 230.09, "methodology": "fee schedule" }, { "payer_name": "Meritain Health", "plan_name": "Meritain Health", "standard_charge_dollar": 518.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "PAI", "plan_name": "PAI", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Premier Access, INC", "plan_name": "Premier Access, INC", "standard_charge_dollar": 518.0, "methodology": "fee schedule" }, { "payer_name": "Selman Co", "plan_name": "Selman Co", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "Sentara Commercial", "plan_name": "Sentara Commercial", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "Sentara Medicare Advantange", "plan_name": "Sentara Medicare Advantange", "standard_charge_dollar": 315.0, "methodology": "fee schedule" }, { "payer_name": "Sentara VA Medicaid - Optima", "plan_name": "Sentara VA Medicaid - Optima", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO BCBS Cover Kids", "plan_name": "TN MCO BCBS Cover Kids", "standard_charge_dollar": 228.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO Blue Care", "plan_name": "TN MCO Blue Care", "standard_charge_dollar": 260.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO BlueCare Plus", "plan_name": "TN MCO BlueCare Plus", "standard_charge_dollar": 228.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO United Healthcare", "plan_name": "TN MCO United Healthcare", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "TN MCO Wellpoint Medicaid", "plan_name": "TN MCO Wellpoint Medicaid", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "UHC GEHA", "plan_name": "UHC GEHA", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "United Behavioral Health Claims", "plan_name": "United Behavioral Health Claims", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "UPMC Health Plan", "plan_name": "UPMC Health Plan", "standard_charge_dollar": 505.0, "methodology": "fee schedule" }, { "payer_name": "VA Aetna BH FIDE", "plan_name": "VA Aetna BH FIDE", "standard_charge_dollar": 505.0, "methodology": "fee schedule" }, { "payer_name": "VA MCO Aetna Better Health", "plan_name": "VA MCO Aetna Better Health", "standard_charge_dollar": 315.0, "methodology": "fee schedule" }, { "payer_name": "VA MCO Anthem HealthKeepers Plus", "plan_name": "VA MCO Anthem HealthKeepers Plus", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": 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Medicare Advantage Plan", "plan_name": "Wellpoint Dual Medicare Advantage Plan", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "WPS", "plan_name": "WPS", "standard_charge_dollar": 518.0, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 325.0, "minimum": 109.59, "maximum": 518.0 } ] }, { "description": "PHP Daily Adult", "code_information": [ { "code": "H0035", "type": "HCPCS" }, { "code": "1010", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UHC Medicare Advantage", "plan_name": "UHC Medicare Advantage", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Dual Medicare Advantage Plan", "plan_name": "Wellpoint Dual Medicare Advantage Plan", "standard_charge_dollar": 300.0, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 325.0, "minimum": 250.0, "maximum": 300.0 } ] }, { "description": "PHP Psych Adult Daily", "code_information": [ { "code": "H0035", "type": "HCPCS" }, { "code": "922", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "90 Degree Benefits - MCA Administrators", "plan_name": "90 Degree Benefits - MCA Administrators", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "AARP United Healthcare Claim Division", "plan_name": "AARP United Healthcare Claim Division", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "ACS Benefits Serivces", "plan_name": "ACS Benefits Serivces", "standard_charge_dollar": 400.0, "methodology": "fee schedule" }, { "payer_name": "Administrative Concepts", "plan_name": "Administrative Concepts", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 572.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare PPO", 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"methodology": "fee schedule" }, { "payer_name": "UHC GEHA", "plan_name": "UHC GEHA", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "UHC Medicare Advantage", "plan_name": "UHC Medicare Advantage", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "United Behavioral Health Claims", "plan_name": "United Behavioral Health Claims", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "UPMC Health Plan", "plan_name": "UPMC Health Plan", "standard_charge_dollar": 505.0, "methodology": "fee schedule" }, { "payer_name": "VA Aetna BH FIDE", "plan_name": "VA Aetna BH FIDE", "standard_charge_dollar": 505.0, "methodology": "fee schedule" }, { "payer_name": "VA MCO Aetna Better Health", "plan_name": "VA MCO Aetna Better Health", "standard_charge_dollar": 109.59, "methodology": "fee schedule" }, { 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"methodology": "fee schedule" }, { "payer_name": "VA Molina Complete Care", "plan_name": "VA Molina Complete Care", "standard_charge_dollar": 109.59, "methodology": "fee schedule" }, { "payer_name": "VA United Healthcare Dual SNP", "plan_name": "VA United Healthcare Dual SNP", "standard_charge_dollar": 109.59, "methodology": "fee schedule" }, { "payer_name": "Vaya Health", "plan_name": "Vaya Health", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Wellcare Medicare Advantage Plan", "plan_name": "Wellcare Medicare Advantage Plan", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Dual Medicare Advantage Plan", "plan_name": "Wellpoint Dual Medicare Advantage Plan", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "WPS", "plan_name": "WPS", "standard_charge_dollar": 518.0, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 325.0, "minimum": 109.59, "maximum": 572.0 } ] }, { "description": "Telehealth PHP CD Adult Daily", "code_information": [ { "code": "H0035", "type": "HCPCS" }, { "code": "858", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Ambetter", "plan_name": "Ambetter", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HOME PLAN", "plan_name": "BCBS HOME PLAN", "standard_charge_dollar": 420.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 420.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Virginia", "plan_name": "BCBS Virginia", "standard_charge_dollar": 401.0, "methodology": "fee schedule" }, { "payer_name": "Carelon", "plan_name": "Carelon", "standard_charge_dollar": 360.0, "methodology": "fee schedule" }, { "payer_name": "Cigna", "plan_name": "Cigna", "standard_charge_dollar": 432.0, "methodology": "fee schedule" 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